Guidelines from the cancer (CCAFU) and infection disease (CI-AFU) committees of the French Association of Urology for the management of adverse events and complications of BCG.

INTRODUCTION Intravesical instillations of BCG are recommended for the treatment of high-risk non-muscle invasive bladder cancer. However, their prolonged use remains limited by potentially serious adverse events (AEs) or complications. The aim of this article is to provide updated recommendations for the diagnosis and management of AEs or complications of intravesical BCG instillations.

MATERIALS A review of the literature was performed using Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com), and the following MeSH keywords or a combination of keywords: "Bladder"; "BCG"; "Complication"; "Toxicity"; "Adverse events"; "Prevention"; "Treatment".

RESULTS AEs or complications of BCG included genitourinary and systemic symptoms. The most common complications (cystitis, moderate fever) should be treated symptomatically and may require BCG adjustment to allow patients to have the most complete BCG course possible. Serious complications are rare but must be identified promptly because of their life-threatening nature. Their management is based on a combination of anti-tubercular treatment, anti-inflammatory drugs, and permanent discontinuation of BCG.

CONCLUSION The management of AEs during BCG therapy requires early identification, rational and effective treatment if necessary, and discussions about the continuation of BCG therapy in each situation.