Name of the Procedure:

• Common Name: BCG Therapy
• Technical Name: BCG Live Intravesical Instillation, 1 mg (J9030)

Summary

BCG therapy involves the bladder instillation of a live, weakened strain of the Mycobacterium bovis bacteria to treat bladder cancer. This solution is placed directly into the bladder through a catheter.

Purpose

BCG therapy is primarily used to treat non-muscle invasive bladder cancer. It aims to trigger an immune response that targets and destroys cancer cells within the bladder lining.

Indications

• Bladder Cancer: Specifically, carcinoma in situ (CIS) and high-grade non-muscle invasive bladder cancer.
• Recurring Tumors: Suitable for patients with frequent recurrence of bladder tumors.

Preparation

• Pre-Procedure Instructions: Patients may be advised to avoid drinking fluids a few hours before the procedure to help them retain the BCG solution in the bladder for the required time.
• Diagnostic Tests: Urine tests to check for infections and cystoscopy to inspect the bladder lining.

Procedure Description

1. Catheter Insertion: A catheter is inserted through the urethra into the bladder.
2. BCG Instillation: The BCG solution is inserted through the catheter into the bladder.
3. Retention Period: The patient holds the BCG solution in the bladder for about 2 hours.
4. Voidance: After 2 hours, the patient urinates to expel the solution.

Tools and Equipment:

• Catheter
• Syringe with BCG solution

Anesthesia or Sedation:

• Typically, no anesthesia or sedation is required.

Duration

The total duration of the procedure, including preparation and retention, is approximately 2-3 hours.

Setting

Typically performed in an outpatient clinic or a hospital's urology department.

Personnel

• Urologist or specialized nurse
• Medical assistant for preparation and monitoring

Risks and Complications

• Common Risks: Bladder irritation, urinary frequency, mild discomfort during urination.
• Rare Complications: Severe infection, high fever, allergic reactions, systemic BCG infection. Management involves prompt medical attention for severe reactions and symptomatic relief for mild side effects.

Benefits

• Expected Benefits: Reduction in tumor recurrence and progression.
• Realization Period: Benefits can be observed within a few weeks to months after completing the treatment course.

Recovery

• Post-Procedure Care: Patients are advised to increase fluid intake to flush the bladder.
• Recovery Time: Minimal downtime; patients can usually resume normal activities the next day.
• Follow-up: Regular cystoscopy and urine tests to monitor for cancer recurrence.

Alternatives

• Intravesical Chemotherapy: Uses chemical agents instead of BCG.
• Surgery: Transurethral resection or radical cystectomy for more invasive cancers.
• Pros and Cons: BCG is less invasive with fewer side effects compared to surgery but requires multiple sessions.

Patient Experience

• During Procedure: Mild discomfort during catheter insertion and bladder filling.
• After Procedure: Possible urinary frequency, burning, and slight discomfort, usually managed with over-the-counter pain relief.
• Pain Management: Mild analgesics if necessary.