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Intravesical BCG is effective for treating patients with superficial bladder cancer, particularly high-grade tumours and carcinoma in situ. It is also useful prophylactically to prevent tumour recurrence after surgical resection.Available evidence suggests that it is more effective than intravesical doxorubicin or thiotepa, and is at least as effective as intravesical mitomycin or epirubicin.Intravesical BCG is generally well tolerated. The most worrisome adverse effect is the risk of disseminated BCG infection. This may be reduced by delaying the use of BCG in patients at highest risk (e.g. after traumatic catheterisation). In addition, the morbidity associated with BCG infection may be reduced by promptly initiating antimycobacterial therapy in patients developing a fever.