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This article presents indications and procedure of BCG instillations, and outlines the effects on recurrence and progression of NMIBC. The BCG\u2010induced immunity in NMIBC is not yet fully understood. Animal studies point towards BCG inducing specific tumour immunity. We describe the current knowledge of how this immunity is induced, from internalization of BCG bacilli in urothelial cells, to cytokine\u2010 and chemokine\u2010mediated recruitment of neutrophils, monocytes, macrophages, T cells, B cells and natural killer cells. In addition, we describe the process of trained immunity, the non\u2010specific protective effects of BCG. Recent studies also indicate that dysbiosis of the urinary microbiome may cause lower urinary tract dysfunction. Side effects of BCG bladder instillations range from common, mild and transient symptoms, such as dysuria and flu\u2010like symptoms, to more severe and rarely occurring life\u2010threatening complications. 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