title: [Practical guideline for the management of adverse events associated with BCG installations].
abstract: OBJECTIVE
  Morbidity secondary to intravesical Bacillus Calmette-Guèrin (BCG) may present both locally and systemically. Most patients suffer a self-limited irritative voiding syndrome. Often, there are not unified criteria for the management of BCG side effects. After treating more than 500 patients with BCG we developed a practical guideline for the management of its morbidity. We present clearly and schematically the practice guideline we follow in our Center when the patient presents symptoms and morbidity secondary to BCG intravesical installations.
  
  
  METHODS
  We analyze and describe, following the literature and our own experience, the management of adverse events experienced by patients treated with intravesical BCG, since the initial implementation of the protocol for its indication in patients with high risk non-muscle invasive bladder tumors and/or CIS.
  
  
  RESULTS
  Irritative voiding symptoms are among the most frequent symptoms, generally self-limited; but if they persist (> 48 hours) will have the urologist treat them depending on intensity and duration. Macroscopic hematuria is not unfrequent and diminishes with an expectant approach and water intake. But, it may also be a urinary tract infection or residual tumor. A febrile syndrome, if present, is usually self-limited to the first 24-48 hours and below 38.5 degrees C without general status affectation. In cases of persistence and/or sepsis, tuberculostatic treatment and/or corticoids should be started. Other clinical pictures may appear, such as orchyoepididymitis, arthritis, etc.
  
  
  CONCLUSIONS
  Proper diagnosis and treatment of adverse events after BCG therapy are basic to allow intravesical immunotherapy be properly prescribed and managed by urologists, enabling a proper treatment of patients and avoiding the possibility of more severe complications.
authors: Servicio de Urología, Fundación Puigvert, Barcelona, España. fprodriguez@hotmail.com
authors: Fernando
authors: F
authors: Rodríguez
authors: Juan
authors: J
authors: Palou
authors: R
authors: R
authors: Martínez
authors: O
authors: O
authors: Rodríguez
authors: A
authors: A
authors: Rosales
authors: Jorge
authors: J
authors: Huguet
authors: Humberto
authors: H
authors: Villavicencio
mesh_terms: D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D003933:Diagnosis; D006801:Humans; D017410:Practice Guidelines as Topic; D013812:Therapeutics
chemical_list: D001500:BCG Vaccine