European Urology

Intravesical bacillus Calmette-Guérin (BCG) induces a cascade of robust immunologic responses in the bladder that conspire to destroy urothelial carcinoma. Although unproven, the same augmented innate and activated immune reactions, as Brausi and Siracusano point out [1], may explain how BCG might also eradicate uropathogens entrenched within the mucosa.

BCG therapy has been shown to be safe and effective in antibiotic-naïve bacteriuric bladder cancer patients [2]. I agree that further studies are necessary to corroborate these findings, especially the collateral damage BCG may cause to chronic bacteriuria [3]. For that to happen, however, urologists must be willing to treat infected patients with BCG and monitor them closely without resorting to frequent use of antibiotics to sterilize the urine. Because of guidelines and traditional practices warning against outpatient urologic procedures in patients with positive urine cultures, that becomes difficult. So far and despite my best efforts, I have been unable to persuade co-investigators at other institutions to participate in such studies, although I am open and happy to share our data and protocols as well as to collaborate in multicenter trials.

Conflicts of interest

The author has nothing to disclose.