THE PERSISTENCE OF BACILLE CALMETTE-GUERIN IN THE BLADDER AFTER INTRAVESICAL TREATMENT FOR BLADDER-CANCER

Objective To determine the incidence of bacille Calmette-Guerin (BCG) bacilli persisting in the urinary tract of patients treated previously with intravesical BCG for carcinoma in situ or multiple Ta.T1 transit ional cell carcinoma. Patients and methods One-hundred and twenty-five patients were treated at the Freeman Hospital, Newcastle upon Tyne, U K over an 8-year period, 90 of whom submitted early morning urine samp les for culture for acid-fast bacilli at varying intervals following B CG treatment. The records of all patients were reviewed to determine t he incidence of caseating granulomata containing acid-fast bacilli tog ether with the incidence of toxicity and the outcome of treatment. Res ults Five patients were found to have persisting acid-fast mycobacteri a in their urine or bladder up to 16.5 months after completing intrave sical instillations of BCG. In one patient this probably accounted for bladder symptoms that required palliative cystectomy. In four patient s the 'infection' was not severe. Two patients were treated with antit uberculous chemotherapy without complication. Three years after intrav esical BCG therapy 36 of 69 patients (52%) had remained tumour free. C onclusion BCG organisms can persist in the urinary tract for at least 16.5 months after the completion of intravesical BCG instillation ther apy.