Bacille Calmette-Guérin intravesical instillation and erectile function: is there a concern?

Abstract

The aim of our study was to evaluate the effect of bacille Calmette-Guérin (BCG) therapy on erectile function in a cohort of male patients affected by non-muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non-muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF-5) and International Prostate Symptom score (I-PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF-5 score was 17.6 +/- 6.7 during therapy and 21.7 +/- 2.92 a month after the last instillation (P=0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post-treatment results (P=0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P=0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non-muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.

Quality of life in patients with non–muscle-invasive bladder cancer: One-year results of a multicentre prospective cohort study

“…Our results should help clinicians to better inform patients of possible benefits and side effects of treatments. Previous publications on NMIBC included 4 crosssectional studies [5,11,13,14], 2 clinical trials evaluating intravesical BCG [17,18], and 3 observational prospective studies [12,15,16]. Of the latter 3, only 2 had pretreatment and posttreatment evaluations [12,16], and none of them used bladder cancer-specific HRQL instruments.…”

“…Currently, there are only a few published studies regarding HRQL in patients with nonmuscle-invasive bladder cancer (NMIBC) [5,[11][12][13][14][15][16][17][18] although patients are mostly diagnosed at this stage of the disease. Taking into account the current evidence gaps regarding HRQL of patients with bladder cancer and its high incidence rates in Spain, we aimed to describe the evolution over time of HRQL (measured by generic and bladder cancer-specific instruments) of Spanish patients with NMIBC and to examine the clinical and treatmentrelated factors associated with HRQL changes during the first year of disease management.…”

Cancer and Sexual Problems

“…There is little research on the impact of treatment for superficial cancer on sexual function in men or women. Intravesical therapy is typically followed by a week of pelvic pain [148] and sometimes temporary ED [149]. One small, cross‐sectional comparative study suggested that men and women receiving intravesical chemotherapy have similar sexual function as those receiving only cystoscopic tumor removal [150].…”

Single center experience of urinary bladder malignancy: a 10-year retrospective analysis of hospital data

“…Concomitant CIS was present in 35.6% (n=48, p=0.063) of the T1 subpopulation and was predominant in male smokers in their sixth decade of life. Nine patients (5.4%) in the NMIBC group underwent adjuvant chemotherapy (AC) in the form of GC [Gemcitabine (1000 mg/m2 I/V on day 1,8,15), Cisplatin (70mg/m2 on day 2)] for a total of 4 cycles, 28 days apart. Patients (n=3) having deranged kidney function and who deteriorated post first cycle of GC were shunted for Carboplatin instead of Cisplatin.…”

“…9,10 Currently there are only a few published studies regarding HRQOL in NMIBC population and the authors of the present study contemplate to evaluate this specific point in their next series. [11][12][13][14][15][16][17][18] (MIBC)…”