Cystoprostatectomy and orthotopic ileal neobladder reconstruction for management of bacille Calmette GuÉrin-induced bladder contractures

Objectives To evaluate the incidence of bacille Calmette-Guerin (BCG)-contracted bladders and attempt to ascertain the potential risk factors for this severe complication. BCG is the most effective intravesical agent for the treatment of high-grade, noninvasive transitional cell carcinoma (TCC) of the bladder. Widely used by urologists for the management of superficial TCC, adverse effects are not uncommon. These adverse effects are most commonly limited to irritative voiding symptoms, hematuria, and fever; however, severe adverse effects may occur. Methods We retrospectively reviewed two cystectomy databases (University of Southern California/Norris Cancer Center and University of Miami Miller School of Medicine) and identified patients who underwent cystectomy and orthotopic neobladder reconstruction for BCG-induced bladder contracture. Results We identified 1 case each in the two institutions’ cystectomy databases of severely contracted bladders. The overall incidence of this complication leading to cystectomy was 0.05% and 0.3% at each institution. Both patients were salvaged with cystoprostatectomy and orthotopic reconstruction with an ileal neobladder. Neither patient had residual cancer at pathologic analysis of the cystectomy specimen, and both patients’ severe lower urinary tract symptoms were alleviated postoperatively. Conclusions A contracted bladder due to extravasation of BCG, although rare, is a serious complication. Cystoprostatectomy with orthotopic neobladder reconstruction may be the optimal solution to alleviate severe lower urinary tract symptoms and remove the risk of subsequent urothelial malignancy.