Complete Response to Intravesical BCG for High-Risk pT1 Bladder Cancer With Lymphovascular Invasion: A Case Report

High-grade non-muscle-invasive bladder cancer (NMIBC) with lymphovascular invasion is rare in young adults. We report a 27-year-old male, a heavy hookah smoker, who presented with painless gross hematuria. Cystoscopy revealed a large papillary bladder tumor. Transurethral resection demonstrated high-grade pT1 urothelial carcinoma with lymphovascular invasion and uninvolved muscularis propria. Repeat resection 4 weeks later confirmed no residual malignancy. The patient received six induction doses of intravesical BCG and remains recurrence-free at follow-up. This case illustrates an uncommon presentation of high-risk NMIBC in a young patient and demonstrates an excellent early response to bladder-preserving therapy despite adverse pathological features.