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A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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BCG Intolerance in Nonmuscle Invasive Bladder Cancer-A Systematic Review.

Claris Oh1, Georgia Bourlotos1,2, Michael O'Callaghan1,3,4

  • 1College of Medicine and Public Health, Flinders University, Adelaide, Australia.

ANZ Journal of Surgery
|August 20, 2025
PubMed
Summary

BCG intolerance causes 12.8% of patients with nonmuscle invasive bladder cancer to stop treatment. Developing strategies to manage side effects is crucial for treatment success.

Keywords:
NMIBCbladder cancerimmunotherapyintoleranceside effectstoxicityurothelial carcinoma bacille calmette‐guerin (BCG)

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Area of Science:

  • Urology
  • Oncology
  • Clinical Trials

Background:

  • Endoscopic resection is standard for localized bladder cancer.
  • Intravesical Bacillus Calmette-Guerin (BCG) is the gold standard for high-grade nonmuscle invasive bladder cancer (NMIBC).
  • 30-40% of NMIBC patients fail BCG treatment due to lack of response, relapse, or intolerance.

Purpose of the Study:

  • To determine the incidence and reasons for BCG intolerance in adult NMIBC patients.
  • To analyze dropout rates associated with BCG therapy for NMIBC.

Main Methods:

  • Systematic review of Embase, MEDLINE, and Cochrane Central Register of Controlled Trials (1974-2023).
  • Included 28 English-language studies reporting BCG discontinuation rates and reasons in NMIBC patients.
  • Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Main Results:

  • BCG dropout rates due to intolerance ranged from 0% to 52%, with an estimated summary proportion of 12.8%.
  • Significant heterogeneity observed across study designs.
  • Dropout rates were dose-dependent (3.3% vs. 20%) and varied by BCG strain (Connaught: 21.1%, Pasteur: 2%).

Conclusions:

  • BCG intolerance leads to an average dropout rate of 12.8% in NMIBC patients.
  • Treatment cessation increases the risk of disease progression or recurrence.
  • Mitigation strategies for BCG intolerance are needed to improve patient outcomes.