Stones aren’t a normal part of the BCG treatment

Dear Dr. Roach: My husband was diagnosed in August 2019 with bladder cancer. In early September 2019, the tumor, part of the lining and end of the ureter were removed and tested, and we were told they got it all. They recommended BCG immunotherapy to prevent recurrence. He had two treatments one week apart beginning October 2019, and started having problems, passing stones then unable to urinate. They inserted a catheter and scheduled a cystoscopy, and restarted therapy.

He completed the therapy in January 2020 and again experienced stones, inability to urinate and again a catheter and cystoscope. We were told they cleaned out the bladder and he needs to drink more water. Within two weeks, we were in the same boat.

The doctor said he had an intense reaction to the immunotherapy and the effects can last a year. But my husband is experiencing the same things over and over.

Is there anything that can be done? — C.V.

Dear C.V.: Bacillus CalmetteGuerin, a bacterium distantly related to tuberculosis, can be instilled in the bladder and cause the body to have a strong local immune reaction. This immune reaction is effective at destroying superficial cancer, and BCG is a common and effective treatment for some cases of bladder cancer.

I have never heard of stones as a complication.

Infection IS a common complication of BCG treatment, and I wonder whether he might have developed an infection that predisposes toward stones. An evaluation of the stone will help guide treatment.

All nephrologists have expertise in stones.

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