Intravesical bacillus Calmette-Guérin outcomes in patients with bladder cancer and asymptomatic bacteriuria

Purpose: The outcome of intravesical bacillus Calmette-Guérin therapy was studied in patients with asymptomatic bacteriuria.

Materials and methods: A total of 243 patients with high risk, nonmuscle invasive bladder cancer received induction intravesical bacillus Calmette-Guérin therapy. Before starting bacillus Calmette-Guérin they submitted voided urine samples for culture and were treated with bacillus Calmette-Guérin regardless of culture results without antibiotics. Patients were followed every 3 months for tumor recurrence or progression up to 2 years.

Results: Of the 243 patients 61 (25%) had significant bacteriuria (greater than 10(4) or greater than 10(5) cfu/ml single organism). Febrile urinary tract infection developed in 1 patient (1.6%) and 2 overall (0.8%) after completing induction bacillus Calmette-Guérin therapy. No patients were admitted to the hospital for bacillus Calmette-Guérin or bacterial sepsis. The 2-year recurrence-free survival rate was 71% vs 73% in uninfected patients (p = 0.73).

Conclusions: These data suggest that intravesical bacillus Calmette-Guérin is safe in patients who have asymptomatic bacteriuria and the 2-year disease-free intervals are similar to those of uninfected patients. Such strategy facilitates the timely administration of bacillus Calmette-Guérin therapy and avoids the overuse of antibiotics.