Volume 10, Number 4Review ArticlesBacillus Calmette-Guérin Failures and Beyond: Contemporary Management of Non–Muscle-Invasive Bladder CancerManagement ReviewMichael S CooksonRichard E GreenbergH Barton GrossmanThomas E KeaneMichael A O'DonnellIn the United States, bacillus Calmette-Guérin (BCG) is the treatment most used for superficial bladder cancer. Patients with carcinoma in situ (CIS) treated with intravesical BCG plus interferon have a 60% to 70% chance of a complete and durable response if they were never treated with BCG or if they failed only 1 prior induction or relapsed more than a year from induction. Intravesical gemcitabine is safe, but its usefulness for BCG-refractory patients is unclear. Valrubicin, approved for intravesical treatment of BCGrefractory CIS of the bladder, has efficacy and acceptable toxicity. Cystectomy should be considered in high-risk, non–muscle-invasive cancer, particularly if intravesical therapy failed. [Rev Urol. 2008;10(4):281-289]Bacillus Calmette-GuérinBladder cancerCystectomyGemcitabine
Volume 16, Number 4Case ReviewThe Use of Botulinum Neurotoxin Type A in a Patient With Refractory Urge Incontinence to Facilitate the Intravesical Treatment of Bladder CarcinomaMina FamPatricia GilhoolyIntravesical Bacillus Calmette-Guérin (BCG) has become the preferred initial treatment after resection of high-grade T1 urothelial carcinoma and carcinoma in situ (CIS). We report the case of a patient with high-grade T1 urothelial carcinoma and CIS who was treated with intravesical BCG. Due to the patient’s severe urge incontinence, however, the BCG solution leaked from the bladder immediately upon instillation. We describe our experience of using botulinum neurotoxin A intradetrusor injections to facilitate successful intravesical therapy by increasing bladder capacity to enable the BCG to remain in the patient’s bladder for the appropriate treatment duration. [Rev Urol. 2014;16(4):194-197 doi: 10.3909/riu0621] This article is a US Government work, and, as such, is in the public domain in the United States of America. Published by MedReviews®, LLC.Bacillus Calmette-GuérinBladder carcinomaBotulinum neurotoxinGemcitabine