Intravesical Treatment
FAQs: Intravesical Therapy (Bladder Instillations)
Section 1: The Basics
Q: What is Intravesical Therapy? A: Intravesical therapy is a treatment where medication is delivered directly into the bladder through a catheter, rather than being injected into a vein (IV) or swallowed. This allows the drug to treat the bladder lining directly while minimizing side effects to the rest of the body.
Q: What is the difference between Intravesical Chemotherapy and BCG? A: They work in different ways:
Intravesical Chemotherapy (e.g., Mitomycin, Gemcitabine): These are drugs that actively kill cancer cells upon contact. They are often given immediately after surgery or as a course of weekly treatments.
BCG (Bacillus Calmette-Guerin): This is a type of immunotherapy. It uses a weakened bacteria to "turn on" your immune system, causing it to attack and destroy bladder cancer cells. It is typically used for higher-risk cancers.
Q: Why do I need this treatment after my tumor has been removed? A: Even after the visible tumor is removed via TURBT, microscopic cancer cells may remain. Intravesical therapy is used to "mop up" these remaining cells to prevent the cancer from growing back (recurrence) or becoming more aggressive (progression).
Section 2: The Procedure
Q: How is the treatment administered? A: You will lie on an exam table. A nurse will clean the urethra and insert a small, flexible catheter into your bladder to drain any urine. The medication is then instilled through the catheter. The catheter is usually removed immediately, and you will be asked to hold the medication in your bladder.
Q: Does the procedure hurt? A: The insertion of the catheter may cause mild discomfort or a "pinch," but it is generally not painful. The medication itself usually does not cause pain while it is in the bladder.
Q: How long do I have to hold the medicine in? A: Typically, you will be asked to keep the medication in your bladder for 1 to 2 hours. During this time, the medication coats the bladder lining.
Section 3: Side Effects & Recovery
Q: Will I lose my hair or get very sick like with regular chemotherapy? A: No. Because the medication stays in the bladder and is not absorbed into the bloodstream, you will not experience typical systemic side effects like hair loss or severe nausea.
Q: What are the common side effects of Intravesical Chemotherapy (Mitomycin/Gemcitabine)? A: Most side effects are local to the bladder. You may experience:
Frequent or urgent need to urinate.
Burning sensation during urination.
Mild skin rash (especially if liquid touches the skin).
Q: What are the side effects of BCG Immunotherapy? A: Since BCG activates your immune system, you may feel like you have the flu for 24–48 hours after treatment. Symptoms include:
Fatigue and low-grade fever.
Chills and body aches.
Burning, urgency, and frequency of urination.
Blood in the urine (common for the first day).
Q: When should I call the doctor? A: You should contact us immediately if you experience:
A fever higher than 101.3°F (38.5°C).
Inability to urinate.
Severe blood clots in the urine.
Symptoms that last longer than 48 hours.
Section 4: Safety & Lifestyle (Important)
Q: Are there special toilet precautions I need to take? A: Yes, specifically for BCG, which contains live bacteria. For 6 hours after each treatment:
Sit down on the toilet to urinate (to avoid splashing).
After urinating, pour 2 cups of undiluted bleach into the toilet bowl.
Close the lid and wait 15–20 minutes before flushing.
Flush the toilet, then wash your hands thoroughly.
Q: Can I drive myself home after treatment? A: Yes. Most patients feel fine immediately after the catheter is removed and can drive themselves home.
Q: Can I have sex during treatment? A: You should abstain from sexual intercourse for 48 hours after each treatment. Furthermore, because BCG and chemotherapy agents can be present in bodily fluids, it is recommended to use a condom during intercourse throughout the entire course of your treatment and for 6 weeks afterward to protect your partner.
PATIENT GUIDE: AFTER YOUR BCG TREATMENT
Keep this card handy for the next 24 hours.
DO: The First 6 Hours (Toilet Safety)
DO sit down on the toilet to urinate to avoid splashing.
DO pour 2 cups of undiluted bleach into the toilet bowl after every time you urinate.
DO close the toilet lid and let the bleach stand for 15–20 minutes before flushing.
DO flush the toilet twice after the waiting period.
DO wash your hands and genital area thoroughly with soap and water after every bathroom visit.
DO: General Recovery
DO drink plenty of water (at least 8–10 glasses) starting 2 hours after your treatment. This helps flush your bladder.
DO rest. It is normal to feel fatigue or "flu-like" symptoms (chills, mild fever, aches) for 24–48 hours.
DO take Tylenol (Acetaminophen) if you have a mild fever or body aches, unless your doctor has told you otherwise.
DON'T: What to Avoid
DON'T hold your urine for too long. Once the 2-hour treatment time is up, empty your bladder regularly.
DON'T engage in sexual intercourse for 48 hours after treatment.
DON'T have unprotected sex for the duration of your treatment course and for 6 weeks after. Use a condom to protect your partner from exposure to the medication.
DON'T share a toilet with children or pets for the first 6 hours if possible. If you must share, ensure the bleach protocol is followed strictly.
⚠️ WHEN TO CALL THE DOCTOR
Contact our office immediately if you experience:
A fever higher than 101.3°F (38.5°C).
Inability to urinate (you feel the urge, but nothing comes out).
Bright red blood in the urine that looks like "ketchup" or has large clots.
Severe pain that does not improve with Tylenol.
Symptoms that last longer than 48 hours.
PATIENT GUIDE: AFTER YOUR BLADDER CHEMOTHERAPY
(Mitomycin C or Gemcitabine)
DO: The First 6 Hours (Toilet Safety)
DO sit down on the toilet to urinate. This is critical to prevent splashing the chemotherapy drug onto your skin or the toilet seat.
DO close the toilet lid before flushing to prevent aerosolizing the chemicals.
DO flush the toilet twice after every use.
DO wash your genital area with soap and water immediately after urinating. If chemotherapy urine stays on the skin, it can cause a painful rash.
DO wash your hands thoroughly after every bathroom visit.
DO: General Recovery
DO drink plenty of fluids (water, juice) starting 2 hours after your treatment. This helps "flush out" your bladder and reduces irritation.
DO check your skin. If you notice any redness or rash on your hands or genital area, wash it immediately and apply a soothing cream if recommended by your doctor.
DON'T: What to Avoid
DON'T hold the medication longer than instructed (usually 1–2 hours). Holding it too long can cause severe bladder irritation (chemical cystitis).
DON'T rely on just wiping. Washing with water is safer to remove chemical residue.
DON'T have unprotected sex for 48 hours after treatment. Use a condom to protect your partner from exposure to the chemotherapy drugs in your bodily fluids.
DON'T worry if your urine is a slightly different color (blue/green for Mitomycin) for the first void; this is normal.
⚠️ WHEN TO CALL THE DOCTOR
Contact our office immediately if you experience:
Allergic Reaction: Widespread itching, rash, or hives on your body.
Inability to urinate (retention).
Severe burning or pain that makes it difficult to urinate.
Fever higher than 100.4°F (38°C).