Intravesical instillations of BCG are recommended for the treatment of high-risk non-muscle invasive bladder cancer. However, their prolonged use remains limited by potentially serious adverse events (AEs) or complications. The aim of this article is to provide updated recommendations for the diagnosis and management of AEs or complications of intravesical BCG instillations.
A review of the literature was performed using Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com), and the following MeSH keywords or a combination of keywords: «Bladder»; «BCG»; «Complication»; «Toxicity»; «Adverse events»; «Prevention»; «Treatment».
AEs or complications of BCG included genitourinary and systemic symptoms. The most common complications (cystitis, moderate fever) should be treated symptomatically and may require BCG adjustment to allow patients to have the most complete BCG course possible. Serious complications are rare but must be identified promptly because of their life-threatening nature. Their management is based on a combination of anti-tubercular treatment, anti-inflammatory drugs, and permanent discontinuation of BCG.
The management of AEs during BCG therapy requires early identification, rational and effective treatment if necessary, and discussions about the continuation of BCG therapy in each situation.
The French journal of urology. 2026 Apr 15 [Epub ahead of print]
Priscilla Leon, Laura I Levi, Thibaut Long Depaquit, François Audenet, Yves Allory, Alexandra Masson-Lecomte, Benjamin Pradère, Thomas Seisen, Evanguelos Xylinas, Gautier Marcq, Thibault Constance, Anne Sophie Bajeot, Doriane Prost, Morgan Roupret, Yann Neuzillet, Maxime Vallée, Mathieu Roumiguié
Service d'Urologie, Clinique Pasteur, Royan, France. Electronic address: ., Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, APHP, Université de Paris Saclay, Le Kremlin-Bicêtre, France., Service d'Urologie, CHU de Marseille, France., Service d'Urologie, Hôpital Européen Georges Pompidou, Université de Paris, France., Service d'Anatomopathologie, Institut Curie, Université de Paris Saclay, Saint-Cloud, France., Service d'Urologie, Hôpital Saint-Louis, Université de Paris, France., Service d'Urologie, Clinique la Croix du Sud, Toulouse, France., Service d'Urologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France., Service d'Urologie, Hôpital Bichat, Université de Paris, Paris, France., Service d'Urologie, CHU de Lille, France., Service d'Oncologie Médicale, France., Service d'Urologie, CHU Institut Universitaire du Cancer de Toulouse, Toulouse, France., Service d'Urologie, hôpital Foch, Université de Paris Saclay, Suresnes, France., Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, F-86000 Poitiers, France; Université de Poitiers, unité INSERM U1070, PHAR2, F-86000 Poitiers, France., Service d'Urologie, Clinique Pasteur, Toulouse, France.