[Complications of endovesical treatment with BCG in a series of 200 patients]. / Complicaciones del tratamiento endovesical con BCG en una serie de doscientos pacientes.

OBJECTIVE: To describe and quantify the side effects of intravesical BCG therapy (Connaught strain) in different therapeutic protocols. METHODS: 200 patients were studied; 126 treated according to the standard protocol of our hospital (modality 1 and modality 2: twelve and nine 81 mg instillations, respectively) and 74 patients in the CUETO protocols (90008, 93009, 95011, 95012). Classification of BCG toxicity was based on the criteria utilized by Lamm which divides it into side effects and complications. We have distinguished side effects further as local irritative symptoms (LIS) and cystitis. RESULTS: The most common side effects were LIS (80%) and cystitis (21.5%). The incidence of cystitis (44.4%) and general malaise (44.4%) was higher for modality 1 than for modality 2 (24.1% and 20.3%, respectively). The CUETO 93009 protocol (mitomycin + BCG) showed the highest incidence of side effects (LIS 100%, cystitis 57.1% and fever < 39 degrees C 71.4%). The most frequent complication was fever > 39 degrees C (4%), followed by hepatitis (3%). The rate of bladder retraction was notably high (1.5%), requiring cystectomy with neobladder substitution in two cases. The overall complication rate for modality 1 (16.6%) was reduced when modality 2 was utilized (8.3%). In the CUETO 90008 protocol, dose reduction did not reduce the complication rate (81 mg: 7.1%; 21 mg: 19.2%). BCG therapy was discontinued in 14%. CONCLUSIONS: Toxicity due to intravesical BCG therapy did not decrease when the dose was reduced, but diminished in number and intensity when the number of consecutive instillations was reduced.

[Reiter syndrome: atypical complication of treatment with BCG]. / Síndrome de Reiter: una complicación atípica del tratamiento con BCG.

OBJECTIVE: To report a case of Reiter's syndrome, an uncommon complication after intravesical BCG therapy. The etiology, clinical features, diagnostic difficulties and treatment of this condition are discussed. METHODS/RESULTS: A 56-year-old patient with superficial bladder carcinoma developed conjunctivitis, urethritis and arthritis of the right knee and wrist after the fourth BCG instillation. Other pathologies were ruled out by the clinical and laboratory findings (synovial fluid, cultures, HLA B-27, RF, ANA). A progressive clinical improvement was observed when BCG instillation was discontinued and treatment with indomethacin was started. CONCLUSION: Reiter's syndrome is an infrequent complication that is not related with the BCG strain utilized. Early diagnosis of this condition improves response to therapy.