Bacillus Calmette-Guérin immunotherapy for refractory interstitial cystitis

Objective: To determine whether or not patients with refractory interstitial cystitis who had failed conservative therapy might benefit from intravesical bacillus Calmette-Guérin (BCG) immunotherapy. Method: Five patients with refractory interstitial cystitis who had failed conservativetherapy underwent six weekly treatments with intravesical BCG. All 5 patients were evaluated before therapy and quarterly thereafter by water cystometry and symptom questionnaire. Results: The average number of medications used daily per patient decreased from 3.2 to 1.2 after therapy. Average volumes of both first desire to void and cystometric capacity doubled after BCG. Improvement in cystometric capacity, average daytime urinary frequency, nocturia, and global pain/discomfort were statistically significant (P = 0.0277, P = 0.0131, P = 0.0199, and P = 0.0317, respectively). Three patients experienced near total relief of their symptoms with six to twelve months' follow-up (average follow-up equals 33.6 weeks). Conclusions: Although the mechanism of action of BCG in interstitial cystitis is unknown,we recommend a double-blind placebo controlled trial to confirm these results and determine an optimal dosage and treatment schedule.