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A systematic review of preventive and therapeutic options for symptoms of cystitis in patients with bladder cancer receiving intravesical bacillus Calmette–Guérin immunotherapy

Poletajew, Sławomira; Krajewski, Wojciechb; Adamowicz, Janc; Radziszewski, Piotra

doi: 10.1097/CAD.0000000000000775

Local adverse effects are the most common clinical issues in patients with bladder cancer receiving intravesical BCG immunotherapy. The aim of this systematic review was to present available options for prevention and treatment of cystitis symptoms related to bacillus Calmette–Guérin (BCG) intravesical instillations. A literature search within the Medline database was conducted in June 2018 with the following search terms: adverse events, Bacillus Calmette–Guerin, BCG, bladder cancer, cystitis, dose, dwell time, dysuria, frequency, intravesical instillations, haematuria, pain, side effects, toxicity and urgency. Eighteen relevant original articles were identified, including 15 randomized controlled trials. Potentially effective options to prevent symptoms of cystitis are BCG dose reduction, intravesical hyaluronic acid instillations and oral prulifloxacin or ofloxacin administration. For the treatment of BCG-related cystitis, available options include oral pentosan polysulphate or a combination of intravesical hyaluronic acid and chondroitin sulphate. The included studies were characterized by high heterogeneity in terms of BCG strains, schedules and endpoints. Studies on treatment of BCG-related cystitis included only small number of patients. Studies on directed medical interventions did not consider the influence on the BCG efficacy. Among few proposed preventive or therapeutic options for symptoms of cystitis related to BCG, none was proven to be both definitively effective and oncologically safe.

aDepartment of General, Oncological and Functional Urology, Medical University of Warsaw

bDepartment of Urology and Oncological Urology, Wrocław Medical University, Wrocław

cDepartment of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland

Correspondence to Sławomir Poletajew, MD, PhD, Department of General, Oncological and Functional Urology, Medical University of Warsaw, 4 Lindleya Street, 02005 Warsaw, Poland Tel: +48 225 021 702; fax: +48 225 022 148; e-mail:

Received November 24, 2018

Accepted February 8, 2019

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