• Reference Number: HEY-666/2023
• Departments: Urology
• Last Updated: 1 November 2023

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is Intravesical Immunotherapy with Bacillus Calmette–Guérin (BCG)?

Your consultant urologist has referred you for treatment of your superficial bladder cancer with Bacillus Calmette–Guérin (BCG).  Superficial bladder cancer affects the inner surface of the bladder only but has the potential to recur or to progress to more aggressive disease. The aim of the treatment is to reduce the risk of new tumours developing in the future by instilling the BCG into the bladder.

BCG is a commonly used vaccine against tuberculosis (TB) and contains bacteria from the same family as TB bacteria. This bacterium has been altered to reduce the risk of infection whilst retaining the ability to stimulate the immune system sufficiently for its beneficial effect. It is not fully understood how BCG works but it is understood that the treatment causes an inflammatory reaction within your bladder that, in turn, activates your immune system to destroy cancer cells. The treatment is given directly into your bladder so it can coat the entire bladder lining and provide the maximum benefit. 

What will happen?

You will usually have your BCG treatment weekly for 6 weeks followed by a break of a few weeks. During this break from treatment the doctor or nurse will arrange for you to have a telescopic inspection of the bladder (cystoscopy). You will then receive a further 3 treatments of BCG. This is called induction therapy.

If the BCG treatment is working well, it can then be given weekly for 3 weeks every 6 months. This is called maintenance therapy and it can be given for up to 3 years. You will have regular cystoscopies throughout this time.

The treatment will be given on the day services department on ward 15 Castle Hill Hospital. You will only need to stay in hospital for a couple of hours and then you may go back home.

The treatment

You should report to the reception on the Day Services department, Ward 15, Castle Hill Hospital.  The nurse will then ask you to provide a urine sample. This is to check that there is no infection or bleeding present when it would be unsafe to give you the treatment. You will then be asked to lie down on a couch and the nurse will insert a fine tube (catheter) through your urethra (waterpipe) and into your bladder. When any urine in there has drained out the nurse will put the BCG solution (approximately half a cup of fluid) into your bladder through the catheter.

The catheter is then removed and you will be asked to try not to pass urine for an hour. You may then sit in the waiting area and are encouraged to move around from time to time as this helps the treatment coat your bladder properly.

After an hour you will need to pass urine after which you may go home. Please tell the nursing staff if you are unable to pass urine after this hour. 

Please tell your nurse if any of the following conditions apply to you:

• You have a urinary tract infection or are feeling poorly from any other illness (if you have an infection your BCG may need to be postponed)
• You are taking antibiotics or immune suppressants (drugs that suppress or reduce the strength of the body’s immune system. They are also called anti-rejection drugs). These medicines can reduce the effects of BCG.
• You have had (or have got) tuberculosis
• You are HIV positive
• You are pregnant or breastfeeding your baby
• You have recently had or are soon due to have a flu injection (you should not have a flu injection for 6 weeks before and after your treatment)
• You suffer from an impaired immune system (reduced immunity against infectious diseases)

Are there any side effects?

 Most procedures have possible side-effects.  Although the complications listed below are well-recognised, most patients do not suffer any problems.

Common (greater than 1 in 10)

• Urinary tract infection (if you get an infection, the next dose of BCG will have to be postponed).
• Some bladder discomfort.
• Flu-like symptoms which can last for 2 – 3 days.
• Urgently needing to pass urine, and wanting to pass urine more frequently, which can last for 2 – 3 days.

Occasional (between 1 in 10 and 1 in 50)

• Narrowing of the urethra (water pipe) following repeated use of a catheter.
• Inflammation which can affect various parts of the body (the liver, joints and the back of the eye).

Rare (less than 1 in 50)

• Persistent or severe pain after treatment, sometimes leading to removal of the bladder.
• Generalised and possibly serious infection with the BCG bacteria needing treatment in hospital with powerful antibiotics.

When I get home

For 6 hours after your treatment you should pass urine sitting down to avoid splashes. Two cups of undiluted household bleach should then be poured into your toilet and left for 15 minutes before flushing.

You should drink plenty of fluids (between 2 and 3 litres per day) for the first few days after treatment. Simple medications such as paracetamol may help to relieve any flu like symptoms.

To protect your partner from transmission of the BCG, it is advisable to refrain from sexual intercourse during the course of your treatment and for a week after your last treatment. The use of a condom may protect your partner as long as it is used correctly and does not tear.

Please contact the department for advice if you feel your symptoms are severe or are not resolving. It is also important to inform the staff if you develop a cough that lasts longer than expected.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Urology Day Services Department on (01482) 622193 or Urology Nurse Specialists on (01482) 622173 / (01482) 626755

Disclaimer

Parts of this leaflet have been produced with the kind permission of the British Association of Urological Surgeons (BAUS) patient information website https://www.baus.org.uk/patients/default.aspx

Every effort has been made to give accurate information but there may still be errors or omissions in this leaflet. BAUS cannot accept responsibility for any loss from action taken (or not taken) as a result of this information.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.