Name of the Procedure:

Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, intravesical use

Summary

BCG therapy involves the introduction of a live attenuated form of the tuberculosis bacterium directly into the bladder to stimulate the immune system to destroy cancer cells. This treatment is specifically used for bladder cancer and is administered through a catheter.

Purpose

The purpose of BCG therapy is to treat superficial bladder cancer. The goal is to prevent the recurrence and progression of bladder tumors by activating the body's immune response to attack any remaining cancer cells after surgical removal.

Indications

• Non-muscle invasive bladder cancer
• High-risk superficial bladder tumors
• Carcinoma in situ (CIS)
• Patients who have had transurethral resection of bladder tumor (TURBT)

Preparation

• Patients may be asked to limit fluid intake for several hours before the procedure.
• A urine sample will be required to rule out any infections.
• Administration of any necessary pre-procedure medications.
• Patients should inform their healthcare provider of any current medications, allergies, or medical conditions.

Procedure Description

1. The patient will lie on an examination table.
2. A catheter is inserted through the urethra into the bladder.
3. The BCG solution is instilled through the catheter into the bladder.
4. The catheter is then removed, and the patient is asked to retain the solution in the bladder for about 2 hours.
5. Patients are instructed to turn from side to side and lie on their back and stomach periodically to ensure the solution contacts the entire bladder lining.

Tools/Equipment:

• Sterile catheter
• BCG solution kit
• Protective gloves and eye protection for healthcare providers

Anesthesia/Sedation:

• Generally, no anesthesia or sedation is required.

Duration

The instillation itself takes approximately 10-15 minutes, but the entire process including the retention period will take around 2 hours.

Setting

BCG therapy is typically performed in an outpatient clinic or hospital setting.

Personnel

• Urologist or oncologist
• Registered nurse or specialized technician

Risks and Complications

Common Risks:

• Bladder irritation or burning sensation
• Frequent and urgent urination
• Low-grade fever

Rare Risks:

• Systemic infection (BCG infection)
• Severe urinary tract infections
• Allergic reactions

Complications Management:

• Antibiotics for infections
• Anti-inflammatory medications for bladder discomfort

Benefits

• Reduction in bladder cancer recurrence
• Potentially prevents progression to muscle-invasive disease
• Long-term cancer control

Recovery

• Patients can resume most normal activities immediately, but should avoid heavy lifting or strenuous activity for 24 hours.
• Drinking plenty of fluids helps flush the bladder.
• Regular follow-up appointments will be scheduled to monitor the bladder and assess treatment efficacy.

Alternatives

• Other intravesical chemotherapy (e.g., Mitomycin C)
• Surgical options like partial or radical cystectomy
• Systemic chemotherapy for more advanced cancer

Pros and Cons:

• BCG tends to have fewer systemic side effects compared to systemic chemotherapy but requires multiple sessions.
• Surgical options may be more effective for certain advanced cases but involve higher risks and longer recovery periods.

Patient Experience

During the Procedure:

• Some discomfort during catheter insertion.
• May experience a full bladder sensation.

After the Procedure:

• Possible bladder irritation or mild fever.
• Urgency and frequency of urination may be increased.
• Pain management involves over-the-counter pain relievers and urinary anesthetics.

Comfort Measures:

• Adequate hydration
• Wearing loose, comfortable clothing
• Pre-procedure relaxation techniques