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Urinary Tract Calculi III: Medical Management01:30

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...

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Reduced Dose Intravesical Bacillus Calmette-Guérin: Why It Might Not Matter.

Ashish M Kamat1, Niyati Lobo1, Seth P Lerner2

  • 1Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Bladder Cancer (Amsterdam, Netherlands)
|July 12, 2024
PubMed
Summary

Optimal dosing and duration for intravesical bacillus Calmette-Guérin (BCG) treatment in non-muscle-invasive bladder cancer (NMIBC) are crucial, especially during BCG shortages. This review summarizes evidence to guide urologists on BCG dose and duration decisions.

Keywords:
Non-muscle-invasive bladder cancerbacillus Calmette-Guerinimmunotherapyreduced dose

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Area of Science:

  • Uro-oncology
  • Cancer treatment immunology

Background:

  • Non-muscle-invasive bladder cancer (NMIBC) is commonly treated with intravesical bacillus Calmette-Guérin (BCG).
  • Optimal treatment protocols for BCG in NMIBC involve determining the appropriate dose and duration of therapy.
  • A global BCG shortage necessitates a review of current evidence regarding dose and duration adjustments.

Purpose of the Study:

  • To summarize the available evidence on the optimal dose and duration of intravesical BCG for NMIBC.
  • To provide guidance for urologists managing NMIBC patients during BCG shortages.
  • To address uncertainties regarding BCG dose and duration compromises during supply limitations.

Main Methods:

  • Systematic review of randomized trials and relevant literature.
  • Analysis of evidence concerning BCG dose-escalation and de-escalation strategies.
  • Evaluation of studies investigating different BCG treatment durations.

Main Results:

  • Evidence suggests that BCG dose reduction may be feasible without compromising efficacy in certain NMIBC patient groups.
  • Shorter BCG treatment durations might be considered in specific contexts, though long-term data are still evolving.
  • Maintaining BCG treatment, even with adjusted dose or duration, is generally preferred over no intravesical therapy.

Conclusions:

  • Urologists should consider evidence-based adjustments to BCG dose and duration to manage NMIBC during shortages.
  • Further research is needed to establish definitive guidelines for modified BCG protocols in NMIBC.
  • Individualized treatment decisions based on patient risk and BCG availability are paramount.