{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T22:25:57Z","timestamp":1766269557925,"version":"3.30.1"},"reference-count":27,"publisher":"Medknow","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["smedj"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>INTRODUCTION Intravesical Bacillus Calmette-Guerin (BCG) therapy is the standard adjuvant treatment for non-muscle-invasive bladder carcinoma (NMIBC) with carcinoma in situ, in addition to tumour resection. We aimed to study BCG complications that preclude adequate treatment of NMIBC in an Asian population. METHODS This retrospective study was conducted using a large, prospectively maintained bladder cancer database. 336 patients received intravesical BCG therapy for bladder cancer in our institution between 2004 and 2016, with an average follow-up duration of 63 months. RESULTS The study included 258 (76.8%) male and 78 (23.2%) female patients. The median age of the patients at diagnosis of bladder cancer was 69 (range 17\u201394) years, and the median number of BCG instillations was 6 (range 1\u201327). 52 (15.5%) patients received maintenance therapy. The most common complications included urinary tract infection with\/without sepsis (n = 18, 5.4%), haematuria (n = 9, 2.7%) and acute urinary retention (n = 4, 1.2%). 93.3% of the patients with complications presented early, within one month of completion of therapy. 22 out of 30 complications were Clavien-Dindo grade \u2264 2. 10 (33.3%) patients were admitted to hospital because of BCG-related adverse effects. The most common reasons for termination were urosepsis (2\/30, 6.7%) and acute urinary retention (2\/30, 6.7%). Patients aged \u2265 80 years at diagnosis were at higher risk of developing BCG-related complications (19.0% vs. 7.5%, p = 0.01). CONCLUSION This retrospective cohort and subgroup study showed that intravesical BCG therapy is well tolerated and has a low incidence of complications even in the elderly and patients with multiple comorbidities.<\/jats:p>","DOI":"10.11622\/smedj.2020168","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T09:54:50Z","timestamp":1606902890000},"page":"325-329","source":"Crossref","is-referenced-by-count":8,"title":["Intravesical Bacillus Calmette-Guerin and its complications: 12 years of learning experience in a single local institution"],"prefix":"10.4103","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7567-5924","authenticated-orcid":false,"given":"X","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Q","family":"Toh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"HH","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LH","family":"Sng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"TT","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LG","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2581","published-online":{"date-parts":[[2022,6]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/S0022-5347(17)58737-6","article-title":"Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors","volume":"116","author":"Morales","year":"1976","unstructured":"1. Morales A, Eidinger D, Bruce AW. Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol 1976; 116:180-3.","journal-title":"J Urol"},{"key":"ref1","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.eursup.2010.08.005","article-title":"Maintenance Bacillus Calmette-Gu\u00e9rin: the standard of care for the prophylaxis and management of intermediate- and high-risk non-muscle-invasive bladder cancer","volume":"9","author":"Lamm","year":"2010","unstructured":"2. Lamm D, Persad R, Colombel M, Brausi M. Maintenance Bacillus Calmette-Gu\u00e9rin: the standard of care for the prophylaxis and management of intermediate- and high-risk non-muscle-invasive bladder cancer. Eur Urol Suppl 2010; 9:715-34.","journal-title":"Eur Urol Suppl"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/01.ju.0000073852.24341.4a","article-title":"Immune mechanisms in Bacillus Calmette-Guerin immunotherapy for superficial bladder cancer","volume":"170","author":"B\u00f6hle A","year":"2003","unstructured":"3. B\u00f6hle A, Brandau S. Immune mechanisms in Bacillus Calmette-Guerin immunotherapy for superficial bladder cancer. J Urol 2003; 170:964-9.","journal-title":"J Urol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.eururo.2012.07.033","article-title":"Epidemiology and risk factors of urothelial bladder cancer","volume":"63","author":"Burger","year":"2013","unstructured":"4. Burger M, Catto JW, Dalbagni G, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 2013; 63:234-41.","journal-title":"Eur Urol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.eursup.2010.08.005","article-title":"The standard of care for the prophylaxis and management of intermediate-and high-risk non muscle-invasive bladder cancer","volume":"9","author":"Lamm","year":"2010","unstructured":"5. Lamm D, Persad R, Colombel, M Braus M. Maintenance Bacillus Calmette-Guerin. The standard of care for the prophylaxis and management of intermediate-and high-risk non muscle-invasive bladder cancer. Eur Urol Suppl 2010; 9:715-34.","journal-title":"Eur Urol Suppl"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"6. Kirkali Z, Chan T, Manoharan M, et al. Bladder cancer: epidemiology, staging and grading, and diagnosis. Urology 2005; 66(6 Suppl 1):4-34.","DOI":"10.1016\/j.urology.2005.07.062"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.eururo.2003.10.006","article-title":"Prognosis of muscle-invasive bladder cancer: difference between primary and progressive tumours and implications for therapy","volume":"45","author":"Schrier","year":"2004","unstructured":"7. Schrier BP, Hollander MP, van Rhijn BW, Kiemeney LA, Witjes JA. Prognosis of muscle-invasive bladder cancer: difference between primary and progressive tumours and implications for therapy. Eur Urol 2004; 45:292-6.","journal-title":"Eur Urol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/S0022-5347(17)39365-5","article-title":"Effects of local Bacillus Calmette-Guerin therapy in patients with bladder carcinoma on immunocompetent cells of the bladder wall","volume":"144","author":"B\u00f6hle","year":"1990","unstructured":"8. B\u00f6hle A, Gerdes J, Ulmer AJ, Hofstetter AG, Flad HD. Effects of local Bacillus Calmette-Guerin therapy in patients with bladder carcinoma on immunocompetent cells of the bladder wall. J Urol 1990; 144:53-8.","journal-title":"J Urol"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"9. Prescott S, Jackson AM, Hawkyard SJ, Alexandroff AB, James K. Mechanisms of action of intravesical bacille Calmette-Gu\u00e9rin: local immune mechanisms. Clin Infect Dis 2000; 31 Suppl 3:S91-3.","DOI":"10.1086\/314066"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"10. Ratliff TL. Role of animal models in understanding intravesical therapy with bacille Calmette-Gu\u00e9rin. Clin Infect Dis 2000; 31 Suppl 3:S106-8.","DOI":"10.1086\/314065"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1016\/j.eururo.2009.11.023","article-title":"The role of Bacillus Calmette-Gu\u00e9rin in the treatment of non-muscle-invasive bladder cancer","volume":"57","author":"Gontero","year":"2010","unstructured":"11. Gontero P, Bohle A, Malmstrom PU, et al. The role of Bacillus Calmette-Gu\u00e9rin in the treatment of non-muscle-invasive bladder cancer. Eur Urol 2010; 57:410-29.","journal-title":"Eur Urol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/j.eursup.2008.08.001","article-title":"Clinical practice recommendations for the prevention and management of intravesical therapy-associated adverse events","volume":"7","author":"Witjes","year":"2008","unstructured":"12. Witjes JA, Palou J, Soloway M, et al. Clinical practice recommendations for the prevention and management of intravesical therapy-associated adverse events. Eur Urol Suppl 2008; 7:667-74.","journal-title":"Eur Urol Suppl"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"13. Rischmann P, Desgrandchamps F, Malavaud B, Chopin DK. BCG intravesical instillations: recommendations for side-effects management. Eur Urol 2000; 37 Suppl 1:33-6.","DOI":"10.1159\/000052381"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/S0022-5347(17)37316-0","article-title":"Incidence and treatment of complications of Bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer","volume":"147","author":"Lamm","year":"1992","unstructured":"14. Lamm DL, van der Meijden PM, Morales A, et al. Incidence and treatment of complications of Bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol 1992; 147:596-600.","journal-title":"J Urol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1111\/j.1442-2042.2010.02678.x","article-title":"Bacillus Calmette-Gu\u00e9rin treatment of non-muscle invasive bladder cancer","volume":"18","author":"Sylvester","year":"2011","unstructured":"15. Sylvester RJ. Bacillus Calmette-Gu\u00e9rin treatment of non-muscle invasive bladder cancer. Int J Urol 2011; 18:113-20.","journal-title":"Int J Urol"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"16. Raheem OA, Kalunian K, Kellogg Parsons J. [Acute arthritis secondary to intravesical Bacillus Calmette-Gu\u00e9rin for bladder cancer]. Actas Urol Esp 2012; 36:461-6. Spanish.","DOI":"10.1016\/j.acuroe.2012.02.002"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1093\/rheumatology\/41.10.1119","article-title":"Reactive arthritis after BCG immunotherapy: T cell analysis in peripheral blood and synovial fluid","volume":"41","author":"Bartolome Pacheco","year":"2002","unstructured":"17. Bartolome Pacheco MJ, Martinez-Taboada VM, Blanco R, et al. Reactive arthritis after BCG immunotherapy: T cell analysis in peripheral blood and synovial fluid. Rheumatology (Oxford) 2002; 41:1119-25.","journal-title":"Rheumatology (Oxford)"},{"key":"ref17","unstructured":"18. Nesher G. Bacillus Calmette-Gu\u00e9rin induced reactive arthritis. J Rheumatol 1999; 26:1638."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1086\/344908","article-title":"Spectrum of bacille Calmette-Gu\u00e9rin (BCG) infection after intravesical BCG immunotherapy","volume":"36","author":"Gonzalez","year":"2003","unstructured":"19. Gonzalez OY, Musher DM, Brar I, et al. Spectrum of bacille Calmette-Gu\u00e9rin (BCG) infection after intravesical BCG immunotherapy. Clin Infect Dis 2003; 36:140-8.","journal-title":"Clin Infect Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/S0302-2838(03)00357-9","article-title":"Maintenance Bacillus Calmette-Guerin for TaT1 bladder tumors is not associated with increased toxicity: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial","volume":"44","author":"der Meijden AP","year":"2003","unstructured":"20. van der Meijden AP, Sylvester RJ, Oosterlinck W, Hoeltl W, Bono AV; EORTC Genito-Urinary Tract Cancer Group. Maintenance Bacillus Calmette-Guerin for TaT1 bladder tumors is not associated with increased toxicity: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial. Eur Urol 2003; 44:429-34.","journal-title":"Eur Urol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/MD.0000000000000119","article-title":"Bacillus Calmette-Gu\u00e9rin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature","volume":"93","author":"P\u00e9rez-Jacoiste As\u00edn","year":"2014","unstructured":"21. P\u00e9rez-Jacoiste As\u00edn MA, Fern\u00e1ndez-Ruiz M, L\u00f3pez-Medrano F, et al. Bacillus Calmette-Gu\u00e9rin (BCG) infection following intravesical BCG administration as adjunctive therapy for bladder cancer: incidence, risk factors, and outcome in a single-institution series and review of the literature. Medicine (Baltimore) 2014; 93:236-54.","journal-title":"Medicine (Baltimore)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.urolonc.2007.04.005","article-title":"Effect of advanced age on the development of complications from intravesical Bacillus Calmette-Gu\u00e9rin therapy","volume":"26","author":"JG","year":"2008","unstructured":"22. Heiner JG, Terris MK. Effect of advanced age on the development of complications from intravesical Bacillus Calmette-Gu\u00e9rin therapy. Urol Oncol 2008; 26:137-40.","journal-title":"Urol Oncol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1016\/S0022-5347(05)00973-0","article-title":"The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy","volume":"175","author":"Joudi","year":"2006","unstructured":"23. Joudi FN, Smith BJ, O'Donnell MA, Konety BR. The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy. J Urol 2006; 175:1634-40.","journal-title":"J Urol"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"24. Costiniuk CT, Sharapov AA, Rose GW, et al. Mycobacterium bovis abdominal aortic and femoral artery aneurysms following intravesical Bacillus Calmette-Gu\u00e9rin therapy for bladder. Cardiovasc Pathol 2010; 19:e29-32.","DOI":"10.1016\/j.carpath.2008.09.003"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1093\/clinids\/17.2.228","article-title":"Molecular confirmation of Bacillus Calmette-Gu\u00e9rin as the cause of pulmonary infection following urinary tract instillation","volume":"17","author":"Kristjansson","year":"1993","unstructured":"25. Kristjansson M, Green P, Manning HL, et al. Molecular confirmation of Bacillus Calmette-Gu\u00e9rin as the cause of pulmonary infection following urinary tract instillation. Clin Infect Dis 1993; 17:228-30.","journal-title":"Clin Infect Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.diagmicrobio.2012.05.026","article-title":"Miliary pulmonary tuberculosis following intravesical BCG therapy: case report and literature review","volume":"74","author":"Colmenero","year":"2012","unstructured":"26. Colmenero JD, Sanjuan-Jimenez R, Ramos B, Morata P. Miliary pulmonary tuberculosis following intravesical BCG therapy: case report and literature review. Diagn Microbiol Infect Dis 2012; 74:70-2.","journal-title":"Diagn Microbiol Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1964","DOI":"10.1016\/S0022-5347(05)64273-5","article-title":"Intravesical Bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials","volume":"168","author":"Sylvester","year":"2002","unstructured":"27. Sylvester RJ, van der Meijden AP, Lamm DL. Intravesical Bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol 2002; 168:1964-70.","journal-title":"J Urol"}],"container-title":["Singapore Medical Journal"],"original-title":[],"link":[{"URL":"http:\/\/www.smj.org.sg\/article\/intravesical-bacillus-calmette-guerin-and-its-complications-12-years-learning-experience","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T23:24:17Z","timestamp":1669937057000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.smj.org.sg\/article\/intravesical-bacillus-calmette-guerin-and-its-complications-12-years-learning-experience"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]},"published-print":{"date-parts":[[2022,6]]}},"URL":"https:\/\/doi.org\/10.11622\/smedj.2020168","relation":{},"ISSN":["0037-5675","2737-5935"],"issn-type":[{"type":"print","value":"0037-5675"},{"type":"electronic","value":"2737-5935"}],"subject":[],"published":{"date-parts":[[2022,6]]}}}