Vol.:(0123456789)
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International Cancer Conference Journal
https://doi.org/10.1007/s13691-018-0331-4
CASE REPORT
A case of ureteral obstruction and sepsis induced by bladder
perforation following intravesical bacillus Calmette–Guérin
successfully treated with an antituberculous agent, antimicrobial
chemotherapy and percutaneous urine drainage
Daichi Morooka
1
· Naotaka Nishiyama
1
· Yoshiki Hiyama
1
· Naoya Masumori
1
Received: 20 March 2018 / Accepted: 25 May 2018
© The Japan Society of Clinical Oncology 2018
Abstract
We report a case of ureteral obstruction and sepsis induced by bladder perforation following intravesical bacillus Calmette–
Guérin (BCG) that was successfully treated non-surgically. A 56-year-old man was diagnosed with non-muscle invasive
bladder cancer. He was treated with intravesical BCG instillation after transurethral resection of the bladder tumor. Just before
the 6th course of intravesical BCG, the patient was diagnosed with bladder perforation and developed ureteral obstruction
and sepsis associated with BCG. He was treated successfully with an antituberculous agent, antimicrobial chemotherapy and
percutaneous urine drainage. Bladder perforation associated with BCG is a very rare adverse event that causes severe sepsis.
Keywords Bladder perforation · Bacillus Calmette–Guérin · Sepsis
Abbreviations
BCG Bacillus Calmette–Guérin
EAU The European Association of Urology
NCCN National Comprehensive Cancer
Network
TURBT Transurethral resection of the bladder
tumor
UC Urothelial carcinoma
Cis Carcinoma in situ
CS Cystoscopy
CT Computed tomography
PNS Percutaneous nephrostomy
PCR Polymerase chain reaction
M. tuberculosis Mycobacterium tuberculosis
E. coli Escherichia coli
ICU Intensive care unit
DRPM Doripenem
FRPM Faropenem
RFP Rifampicin
INH Isoniazid
EB Ethambutol
AE Adverse event
MMC Mitomycin C
Introduction
Intravesical bacillus Calmette–Guérin (BCG) therapy is use-
ful for adjuvant treatment of patients with high- and inter-
mediate-risk non-muscle-invasive bladder cancer (NMIBC)
[1–3]. The European Association of Urology (EAU) and
National Comprehensive Cancer Network (NCCN) guide-
lines recommend that patients with high- and intermediate-
risk NMIBC should be offered BCG therapy [4, 5]. The
EAU guideline states that the optimal BCG schedule for
induction BCG instillation is once weekly for 6 weeks.
For optimal efficacy, BCG must be given on a mainte-
nance schedule. However, intravesical BCG treatment,
despite its efficacy for tumor control, has a high frequency
rate of adverse events (AEs). The most common AEs are
cystitis, hematuria and fever, whereas a severe systemic
adverse reaction that requires anti-tuberculosis chemother-
apy and intensive care is rare [1, 6, 7]. Here, we report the
case of a patient who had bilateral ureteral obstruction and
sepsis induced by bladder perforation following intravesi-
cal BCG instillation who was successfully treated with an
* Naotaka Nishiyama
nishiyan@sapmed.ac.jp
1
Department of Urology, Sapporo Medical University
School of Medicine, South 1, West 16, Chuo-ku, Sapporo,
Hokkaido 060-8543, Japan
@Phil_Robichaud
@deepthiw
@JoseServera