Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy.
Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy.
Urol Oncol. 2021 Feb;39(2):85-92. doi: 10.1016/j.urolonc.2020.11.037. Epub 2020 Dec 8.
Intravesical Bacillus Calmette-Guèrin (BCG) is an effective treatment in non--muscle-invasive bladder cancer, however, extravesical BCG infection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCG infection after intravesical administration of BCG could be identified and estimated for each single involved organ.
We performed a systematic literature review over systemic and genitourinary BCG infection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCG infection development were collected and analyzed for each patient.
BCG infection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed.
BCG infection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCG infection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.
膀胱内卡介苗（BCG）是治疗非肌层浸润性膀胱癌的有效方法，然而，BCG 可引起膀胱外感染，是一种潜在的严重并发症。研究人员旨在评估是否可以识别并估计每个受累器官的膀胱内 BCG 给药后不同时间发生的 BCG 感染。
我们对全身和泌尿生殖道 BCG 感染病例报告进行了系统的文献回顾，共纳入 271 篇已发表的病例报告，总计 307 例患者。收集并分析每位患者的人口统计学数据、临床特征和 BCG 感染发展时间。
BCG 感染的发生时间因受累器官而异，与最后一次灌注之间存在不同的时间间隔。在泌尿生殖系统并发症中，阴茎病变最早发生于 1（1；3）周，而附睾炎发生于 56（6.25；156）周后。与此同时，肉芽肿性肝炎和肺部受累，如粟粒性肺结核，更早发生，中位时间分别为 1（1；4）和 1（1；6）周，而血管、骨关节炎和肌肉并发症的中位时间分别为最后一次灌注后 52（20；104）、68（14；156）和 93（29；156）周。分析还发现，肺部、肝脏和骨髓并发症与肌肉、骨关节炎或血管并发症之间存在聚类关系。
膀胱癌膀胱内 BCG 治疗后，BCG 感染可能在最后一次灌注后数月甚至数年后发生，具体取决于受累器官。当 BCG 感染累及一个或多个器官时，常见的关联模式有两种：一种涉及肺部、肝脏和骨髓，发生较早，但微生物学诊断率较低；另一种涉及肌肉、骨关节炎或血管区，发生较晚，但微生物学证据率较高。
