Evolution of the urothelial bladder field after intravesical Bacille Calmette-Guérin therapy

After transurethral resection (T.U.R) and open surgery of 178 patients with superficial bladder tumors (pTa, pT1) we applied intravesical Romanian (modified Pasteur strain) Bacille Calmette-Guérin therapy. An introduction phase consisting of 8 weekly instillations was followed by a maintenance phase of instillations monthly for 10 months and then 3 monthly for 2 years. Two cases with primary Carcinoma in situ (Cis) were treated with the same protocol. The random urothelial biopsies (4 quadrant) showed before immunotherapy 105 cases (58.33%) with simple (36 cases), medium (36 cases), severe (13 cases) dysplasia and Cis (20 cases) and after 3 years of treatment we found 37 cases (20.55%) with simple (14 cases), medium (14 cases), severe (9 cases) dysplasia and two cases with invasive stage after Cis. The response rate was 75, 55% at 3 years. The mean period of follow up was 50 months. The complications of this therapy were frequent but mild. These results demonstrated the dynamic evolution of the urothelial bladder field after "long-course treatment" with intravesical BCG.