Advice after your nerve block for surgery
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What is intravesical Immunotherapy?
Intravesical Immunotherapy is used as a treatment for superficial bladder cancer (cancer which is confined to the inner surface layer of the bladder).
Immunotherapy stimulates your body’s immune system to destroy cancer cells within the bladder and reduces the risk of the tumour re-growing.
Intravesical Immunotherapy uses a live vaccine called Bacillus Calmette-Guerin (BCG), which is also used to inoculate against Tuberculosis; when placed in the bladder a local inflammatory reaction is created which kills cancer cells.
Treatment involves placing a small amount of fluid, containing a live vaccine, into the bladder through a fine-bore catheter, which is then removed.
Treatments are normally given once a week for a number of consecutive weeks.
Because a live vaccine is used, certain precautions need to be used to reduce the risk to yourself and family; please take time to read this information.
How effective is treatment?
This will depend on how aggressive (Grade) and how deep (Stage) the bladder cancer is.
Approximately 7 out of 10 people (Refs 1,2) with aggressive (Grade 3), superficial bladder cancer and/or carcinoma in-situ will respond to treatment.
Sometimes, even for those people who have had successful BCG treatment, the bladder cancer may return and require further removal and surgery.
How is the treatment given?
The treatment cannot be given immediately after your operation, so an appointment will be arranged to see you with the results of any tissue analysis from the operation and a plan can be made about further treatment, which may be necessary.
A further appointment will be sent to you for the first treatment of BCG.
The treatment is given in clinic as an outpatient by a Urology Nurse Specialist.
- Before the first treatment is given you will be asked questions about any previous illnesses, operations or medication you may be taking. It would be useful to bring a list of current medicines with you (some medicines may interfere with the way BCG works).
- Please bring a urine specimen; we will test this to make sure there is no infection.
- If you have had Rheumatic Fever or artificial heart valve replacements, please let us know in advance as we may need to give you antibiotic prophylaxis before the treatment.
- After making yourself comfortable on an examination couch, the genital area will be cleaned with some antiseptic solution, an anaesthetic gel may be used and a fine catheter is inserted into the bladder, via the urethra.
- The BCG treatment is then passed through the catheter into the bladder and the catheter is then removed.
- You will be asked not to pass urine for the next 2 hours.
- Once the catheter has been removed, you may go home or stay in the department.
Do I need to do anything before treatment?
- Please do not drink any fluids for 2- 4 hours before treatment; this will reduce the amount of urine you make so you can be comfortable and retain the treatment for two hours.
- If you take diuretic medicines (“water tablets”), you should take them after treatment or at least 6 hours before the appointment.
- Ensure you bring a urine specimen with you. We will test to make sure there is no infection present. If there were then we would have to postpone the treatment and prescribe some antibiotic, as infection makes complications more likely.
- If you feel unwell, or are unable to make the appointment, please let us know as soon as possible.
Are there any special precautions after treatment?
- You should sit down when passing urine for the 6 hours after treatment. This reduces the risk of spillage onto skin or outside the toilet. Also, washing around the genital area (with soap and water after each pee) is recommended during this period.
- Before flushing, add two cups of undiluted household bleach into the toilet, leave for 15 minutes and then flush; this should continue for the 6 hours following treatment.
- Ensure no one else uses the toilet before flushing.
- Make sure you wash your hands thoroughly each time
- In order to protect your partner, you should abstain from sexual activity for 48 hours following treatment and use a condom during intercourse during the course of treatment and for six weeks after completion of treatment.
- Drink plenty of fluids (2-3 litres) for the first 24 hours following treatment avoid caffeine drinks e.g. coffee, cola etc; use decaffeinated drinks, cranberry juice and barley waters.
BCG advice for patients with immunocompromised partners
"Patients treated with BCG-medac (Mycobacterium bovis) should employ adequate hygienic measures if in contact with immunosuppressed patients. Mycobacterium bovis is less pathogenic than Mycobacterium tuberculosis and man-to-man transmission has not been reported yet, but it cannot be excluded especially in immunosuppressed patients."
In terms of sexual transmission, there have been no reported cases.
However, the manufacturer recommends to refrain from intercourse or use a condom for one week after BCG therapy.
Are there any side effects?
Approximately 9 out of 10 people having BCG treatment will develop some side effects; these usually begin within 3-4 hours after treatment and may last 1 -3 days.
Most commonly, these include:
- Pain when passing urine and passing urine more frequently; this may feel like cystitis. Drinking plenty of fluids will help reduce these symptoms; avoiding caffeinated drinks may reduce the frequency in passing urine.
- However, if they continue to last more than 3 days, then contact your GP.
You will have to ring 111, or attend A&E if you develop any of these symptoms:
- High temperature (above 39ºC)
- Vomiting
- Joint pain
- Skin rash
- Cough
At the end of treatment, arrangements will be made for you to have a further cystoscopy, please contact our Urology Secretary FPH 0300 613 6305 or HWD/WPH urology secretary 0300 615 3053 if you do not hear about this appointment. It is important that we examine the bladder lining to assess how the treatment has worked. Part of this assessment would involve taking biopsies from the bladder lining.
Sometimes, we ask for urine specimens to see if there are cancer cells present in the urine.
Further BCG treatment may be necessary; this is called a maintenance course. If you are due to have maintenance BCG and have not received a date for treatment, please contact us.
Contact us
If you have any queries relating to this information, please contact the Urology service.
About this information
Service:
Urology
Reference:
Z/013
Approval date:
29 July 2024
Review date:
1 July 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.