Late bacille Calmette-Guérin infection with a large focal urinary bladder ulceration as a complication of bladder cancer treatment.

OBJECTIVE: • To report a late bacille Calmette-Guérin (BCG) complication previously not described in the literature. PATIENTS AND METHODS: • We reviewed our database with 858 patients treated with BCG from 1986 to 2008 and identified 13 male patients (1.8% of all male patients) who had a large tuberculous-like bladder ulcer. RESULTS: • All patients had high-grade tumours and seven had tumours invading lamina propria before BCG treatment. A solitary ulceration or inflammatory lesion, 10-50 mm in diameter, was seen at routine follow-up cystoscopy 2-34 months (median 8 months) after the first instillation. Significantly more patients had been treated with BCG-RIVM than with BCG-Tice (10/320 vs. three of 454, P < 0.01). BCG was cultured from urine 3-34 months (median 14 months) after the last instillation. • So far, eight patients have been successfully treated with rifampicin and isoniazid. Nine patients are still tumour-free 15-66 months (median 44 months) after the last transurethral resection before BCG treatment. • Another three patients had one to two non-invasive recurrences. One patient had an invasive recurrence and underwent cystectomy. The present study is limited by biases associated with its retrospective design. CONCLUSIONS: • This is the first report on persisting BCG infections with large inflammatory lesions in the bladder. Treatment is effective and the oncological outcome is good. • Mycobacterial cultures of the urine should be performed in BCG-patients with unclear inflammatory lesions in the bladder since a delayed diagnosis of a persistent BCG infection could result in a permanently reduced bladder capacity. • Large studies are warranted to study differences in efficacy and side-effects between different BCG strains.

Does mast cell density predict the outcome after transurethral resection of Hunner's lesions in patients with type 3C bladder pain syndrome/interstitial cystitis?

OBJECTIVE: This study aimed to assess mast cell density in the lamina propria for possible correlation with duration of symptom amelioration after transurethral resection of the bladder (TURB). MATERIAL AND METHODS: Twelve patients (eight women and four men) referred to the tertiary referral facility, treated between June 2003 and June 2009, were included in the study. All had undergone three consecutive complete TURB procedures, where the first one was also diagnostic. All patients fulfilled the NIH-NIDDK criteria and the ESSIC bladder pain syndrome/interstitial cystitis type 3C criteria; they had Hunner's lesions and biopsy findings with inflammatory infiltrates, granulation tissue and mastocytosis. Bladder biopsies were evaluated for mast cell density by immunochemistry and symptom amelioration was recorded by self-report of symptom relapse. RESULTS: Median mast cell density in the lamina propria at the first, second and third TURB was high. No statistically significant correlation between mast cell density in the urothelium, lamina propria or detrusor, and duration of symptom amelioration could be seen after the first, second or third TURB. CONCLUSION: Mast cell density does not appear to correlate with duration of symptom amelioration after complete transurethral resection of Hunner's lesions, either in the lamina propria or in the urothelium or detrusor.