Managing Adverse Events With Intravesical Therapies

This segment addresses recognizing and managing adverse events, with nurses described as the care team's eyes on the ground. The faculty monitor for signs of systemic absorption, including fever, chills, fatigue, nausea, and vomiting, and note that lab work can reveal problems before symptoms appear. Local effects include urinary retention, bladder spasms, and increased susceptibility to urinary tract infection (UTI). Most can be managed in clinic or by phone. The panel contrasts side effect profiles. Bacillus Calmette-Guérin (BCG) commonly causes UTI-like and flu-like symptoms that tend to be cumulative, and rare BCG sepsis can be life-threatening. Gemcitabine plus docetaxel and reverse thermal mitomycin gel mainly cause localized, self-limited urinary symptoms, with rare urethral stricture and uncommon systemic reactions. On escalation, the faculty describe reviewing urinalysis results and new symptoms before each treatment, and holding treatment for a urine culture when infection is suspected. They note that nitrite positivity alone does not always mean infection, and that clear protocols help nursing staff know when to contact the provider.