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atal Outcome Caused by Intravenousnfusion of Bacille Calmette-Guérin

O THE EDITOR:

e are writing to share a dramatic incident withatastrophic consequences. We believe it is importanthat this incident be made known to our colleagues.

e recently treated a 39-year-old man who presentedo the urology clinic with macroscopic hematuria. Theadiologic workup revealed a very large tumor thatlled the bladder lumen and no signs of systemicpread. On cystoscopy, the tumor filled the entireladder, but it was a papillary tumor connected to theladder wall by an approximately 1-cm-thick stalk.he tumor was resected transurethrally, and histologicnalysis revealed high-grade urothelial carcinoma withnvasion of the lamina propria. The muscle layer wasree of tumor. A second resection was performed after

weeks with no histologic evidence of residual tumoround. A decision was made for intravesical bacillealmette-Guérin (BCG) immunotherapy. Because theatient lived in another city, he wanted to receive thereatment in his hometown. Cystoscopy was plannedfter 6 weeks of intravesical BCG immunotherapy, anddetailed letter was written to his local urologist so

hat he could receive the weekly BCG instillations inis hometown. The patient received the first 3 intra-esical BCG instillations with no adverse events. Athe fourth weekly instillation, a nurse gave him theCG by intravenous infusion, despite the patient’sbjections. He was referred to another university hos-ital immediately after the infusion, which had causedhigh fever, nausea, and shivers. After 1 week of

reatment, he was referred to our hospital because ofhe worsening of his condition. At that time, he had aigh fever, nausea, emesis, malaise, and jaundice. Head a tender abdomen, with an enlarged liver andlevation of the liver and kidney function test results.he patient was immediately admitted to the intensiveare unit with a diagnosis of BCG sepsis and multior-an failure. Consultations were obtained from the de-artments of infectious diseases, nephrology, and gastro-nterology, and he received broad-spectrum antibioticreatment. His condition worsened despite the treatment,nd he developed gastric perforation that was repairedurgically. He died of multiorgan failure 3 weeks after thentravenous infusion of BCG.

We would like to stress that the proper administrationf BCG is the responsibility of the treating urologist and

hould never be taken lightly. Preparation of the BCG

18 © 2010 Published by Elsevier Inc.

olution and intravesical instillation should always beerformed by a urologist or a physician under the super-ision of a urologist.

Umit Gul, M.D.Baris Kuzgunbay, M.D.Ozgur Yaycioglu, M.D.

Department of UrologyBaskent University School of Medicine

Ankara, Turkey

e: Steinberg et al.: YouTube as Sourcef Prostate Cancer Information (Urology010;75:619-622)

O THE EDITOR:

he authors have rightfully concluded that the Internets often the first-line source of health care information formericans and that YouTube is an inadequate source of

rostate cancer information for patients. Any video willf course harbor the biases and opinions of its creator andust be “taken with a shaker of salt.”Urologists can attempt to rectify some of the misin-

ormation disseminated on the Internet by construct-ng their own videos with the intent of providingatients with information that supplements and/or re-nforces the educational process initiated in the office,s I have done for the past several years. My first videoas on pelvic floor exercises, the impetus of which was

o avoid the repetition and time expenditure requiredo educate patients on this subject. With the surprisinguccess of that video—more than 70,000 views—xtending way beyond my own patient population, Ireated additional videos on urological topics, includ-ng incontinence, pelvic relaxation, prostate enlarge-ent, prostate cancer, bladder cancer, and erectile

ysfunction, as well as several videos on lifestyle issues,ncluding exercise, healthy eating, processed foods andmoking. They can be accessed at the following webite: http://www.youtube.com/incontinencedoc.

Andrew Siegel, M.D.Hackensack University Medical Center

Hackensack, New Jersey

UROLOGY 76: 518–519, 2010 • 0090-4295/10/$34.00doi:10.1016/j.urology.2010.05.016