Post-Bacillus Calmette-Guérin Cystitis: A Systematic Review of the Literature

Intravesical Bacillus Calmette-Guérin (BCG) is used as adjuvant therapy for intermediate-risk and high-risk non-muscle invasive bladder cancer (NMIBC). While it is generally well-tolerated, approximately 2.9% of patients receiving intravesical BCG discontinue immunotherapy as a result of genitourinary infection. We conducted a comprehensive systematic review of the contemporary literature to understand the presentation, evaluation, and treatment of post-BCG cystitis. This systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA).

Post-BCG cystitis is categorized into two groups: chemical cystitis and bacterial cystitis. Chemical cystitis presents as irritative voiding symptoms and spontaneously resolves, while bacterial cystitis requires further treatment. Early, localized symptoms may be improved by NSAIDs and bladder relaxants if urgency is a predominant symptom. In some cases, BCG cystitis resolved with conservative medical treatment. In BCG cystitis that persists, the standard treatment is isoniazid, rifampin, and ethambutol. If not responsive to medical treatment, radical cystectomy is an option.

Intravesical BCG remains the recommended treatment to decrease the risk of progression and recurrence of NMIBC. An untoward adverse effect is post-BCG cystitis, which can result in significant distress to patients. Future studies are warranted to evaluate various measures to decrease the incidence of post-BCG cystitis and increase BCG therapy completion rate.