Side Effects of Traditional Cystoclysis
Traditional cystoclysis (bladder irrigation/instillation therapy) commonly causes lower urinary tract symptoms including frequency, urgency, and dysuria, with pain and discomfort being the most frequently reported side effects.
Primary Local Side Effects
Lower Urinary Tract Symptoms (Most Common)
- Frequency, urgency, and dysuria occur in the majority of patients undergoing bladder instillation procedures 1
- Pain and discomfort during and after the procedure are consistently reported complications 1
- Bladder spasms develop as part of the inflammatory response to the instillation 1
Hematuria and Bleeding
- Blood in the urine occurs in up to 17.2% of bladder procedures 1
- This represents a common transient complication that typically resolves without intervention 2
Other Local Complications
- Bladder pain and prostatitis/epididymitis are documented side effects 2
- Urinary tract infection is a recognized risk with any bladder instrumentation 1
- The infection risk with cystoscopy-related procedures ranges from 0.85% for symptomatic UTI to 5-21% for positive urinalysis findings 2
Severe Complications (Rare)
Structural Changes
- Bladder contracture can develop with chronic inflammation from repeated instillations, though this remains a rare event across all intravesical therapies 2, 1
- This complication may necessitate surgical intervention in refractory cases 2
Infectious Complications
- Sepsis, while rare, represents a serious potential complication occurring in approximately 0.15% of bladder procedures 2
- Febrile urinary tract infections occur in 1.4-3.7% of cases 2
Systemic Side Effects
When cystoclysis involves immunotherapy agents (such as BCG):
- Fever, chills, and flu-like symptoms are more common with immunotherapy regimens (57% with induction plus maintenance BCG) compared to chemotherapy alone (22-24%) 2
- Systemic immunologic reactions including arthralgia and skin rash can occur 2
- Other systemic effects include malaise, fatigue, nausea, altered liver function, and rarely cardiovascular or neurologic symptoms 2
Treatment Discontinuation
- Patient discontinuation due to side effects occurs fairly frequently, especially with immunotherapy regimens, though exact rates are underreported in the literature 2
- The risk-benefit ratio must be carefully weighed, particularly for low-risk lesions where serious side effects may outweigh potential benefits 2
Clinical Context and Risk Stratification
For patients with high-risk tumors carrying substantial progression risk, the potential benefits of intravesical treatments generally outweigh the risk of serious complications 2. However, for low-risk lesions, single-dose intravesical chemotherapy is preferred over more aggressive regimens to minimize side effect burden 2.
The severity and frequency of complications increase with: