Name of the Procedure:

• Common Name: BCG Therapy
• Technical/Medical Term: Bacillus Calmette-Guérin (Intravesical) Per Instillation (J9031)

Summary

BCG therapy involves inserting a liquid containing live, weakened bacteria into the bladder through a catheter. It is a form of immunotherapy primarily used to treat bladder cancer by stimulating the body's immune system to attack cancer cells.

Purpose

• Medical Conditions: Primarily used for non-muscle invasive bladder cancer, particularly carcinoma in situ.
• Goals: To eliminate or reduce cancer cells in the bladder, prevent recurrence, and support remission.

Indications

• Symptoms/Conditions: Presence of non-muscle invasive bladder cancer.
• Patient Criteria: Diagnosed with early-stage bladder cancer, particularly those who have not responded adequately to other treatments.

Preparation

• Pre-Procedure Instructions:
  • Ensure an empty bladder before the procedure, typically by urinating right before.
  • Avoid drinking large amounts of fluids 4 hours prior.
• Diagnostic Tests/Assessments: Cystoscopy and urine tests to determine the extent of bladder cancer and ensure suitability for BCG therapy.

Procedure Description

1. The patient lies down, and a catheter is inserted through the urethra into the bladder.
2. The BCG liquid is instilled into the bladder through the catheter.
3. The catheter is then removed.
4. The patient holds the BCG liquid in their bladder for about 2 hours.
5. After 2 hours, the patient urinates to expel the BCG liquid.
   • Tools/Equipment: Urinary catheter, sterile BCG solution.
   • Anesthesia/Sedation: Typically none, but local anesthesia may be used for catheter insertion if required.

Duration

The procedure takes approximately 20 to 30 minutes for the instillation, with an additional 2 hours for retaining the solution in the bladder.

Setting

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

Personnel

• Urologist or trained nurse.
• Support staff may assist in the preparation and monitoring of the patient.

Risks and Complications

• Common Risks: Bladder irritation, urinary frequency, and burning sensation.
• Rare Risks: Systemic infection (BCG sepsis), high fever, or allergic reactions.
• Management: Adverse effects are managed with medications and close monitoring; severe cases may require hospitalization.

Benefits

• Expected Benefits: Reduction of cancer cells in the bladder, lower risk of cancer recurrence.
• Onset of Benefits: Can vary; some patients see improvements within weeks, while for others, it may take several treatment sessions.

Recovery

• Post-Procedure Care: Drink plenty of fluids to flush the bladder, avoid sexual activity for 48 hours, maintain personal hygiene.
• Recovery Time: Generally quick, with most patients resuming normal activities within a day.
• Follow-up: Regular follow-up cystoscopies and urine tests to monitor the bladder.

Alternatives

• Other Treatment Options: Surgery (TURBT, cystectomy), chemotherapy (intravesical or systemic), radiation therapy.
• Pros and Cons: Surgery can be more invasive; chemotherapy has broader systemic effects. BCG is typically less invasive but may involve repeated treatments and mild side effects.

Patient Experience

• During the Procedure: Discomfort from the catheter insertion, mild burning sensation.
• After the Procedure: Frequent urination, burning sensation while urinating, mild fatigue. Over-the-counter pain relievers and staying hydrated can help manage discomfort.