Intravesical immunotherapy

What is this?

Instillation of BCG into the bladder for aggressive or recurrent superficial cancer of the bladder

What alternatives are there?

Repeated cystoscopy, radiotherapy, surgical removal of the bladder with urinary diversion or bladder reconstruction, systemic chemotherapy

What to expect before procedure

Your Consultant Urologist has referred you for treatment of your superficial bladder cancer. Superficial bladder cancer affects the inner surface of the bladder only but has the ability to progress to more aggressive disease. The aim of the treatment, therefore, is to stop or slow down re-growth by instilling a drug into the bladder; this is called intravesical immunotherapy. The treatment recommended for you is BCG. BCG is a commonly-used vaccine against tuberculosis (TB) and contains a bacterium from the same family as the TB bacterium which has been altered (attenuated) to reduce the risk of infection whilst retaining the ability to produce the immune reaction needed for its beneficial effect. It has been shown that putting liquid containing BCG vaccine into the bladder is an effective treatment for bladder cancer. Like all powerful treatments, it comes with some possible side-effects (see below) and the risk of these should be considered against the risk of the bladder cancer for which the treatment is being given. There is also some evidence that BCG treatment can interact with influenza vaccine; for this reason, it is recommended that you do not undergo vaccination against influenza within 6 weeks of having an instillation of BCG. The first course is called the Induction Course and lasts for 6 weeks. Following completion of this, you will enter a program of treatment lasting approximately 3 years which includes several doses of BCG, each one preceded by a flexible cystoscopy. The main reasons for patients failing to complete the full course are side-effects (see below) and/or disease progression/ You should limit your fluid input for 6 hours before each treatment. Your first treatment will take up to 3 hours and, depending on how well you tolerate the first treatment, future visits will take approximately 30 minutes. On arrival in the clinic, you will be asked to pass urine which will be tested to ensure that you do not have an infection in the urine. If you do, your treatment will need to be postponed for one week while you are treated with antibiotics.

What happens during the procedure?

A fine plastic tube (called a catheter) will be passed into the bladder and the medication (approximately half a cup of fluid) will be given through it. The catheter will then be removed. You will be asked not to pass urine for two hours to allow the medication to treat the bladder lining. On your first visit, you will be asked to stay in the clinic for the duration of the treatment and you will be asked to pass urine before you go home. For the remaining treatments, If you live within 20 minutes of the hospital and have your own transport, you may be allowed to go home with the medication in your bladder and pass urine after two hours.

After the procedure

Once the treatment has been completed, you will be able to go home. Urine passed within the first 6 hours after you have been treated should be disinfected by pouring a quantity of undiluted household bleach (equal to the amount of urine passed) into the toilet; this should then be left for 15 minutes before flushing the toilet. You should drink plenty of fluids (2-3 litres) for the few days after the treatment. Some patients find that, for a few days after BCG treatment, a glass of cranberry juice daily eases any bladder symptoms; cranberry juice, however, should not be used If you are taking Warfarin

Potential side effects