Bcr test in urology, how is bladder

Bladder instillation with BCG

Dear Patient,

You have been diagnosed with a tissue change in the bladder. A tissue examination revealed that it was a bladder carcinoma. If, as in your case, bladder cancer only grows in the top layers of the bladder wall, it can usually be completely removed with an operation through the urethra. Bladder carcinomas, however, have a tendency to recur in the same or another place in the bladder, i.e. to recur. Immunotherapy was recommended to prevent or delay a possible recurrence of the disease. Immunotherapeutic agents are substances that stimulate the body's own cells to defend themselves against tumors. A preparation made from living bacteria is used for irrigation into the bladder (intravesical instillation) (Bacillus-Calmette-Guérin = BCG), which cause local inflammation in the bladder, similar to a vaccination. This inflammatory reaction is an important prerequisite for the treatment to work and occurs when the body's own defense cells are active in the bladder.

How is bladder instillation performed?
BCG instillation takes place via a thin catheter inserted into the bladder through the urethra, which is then removed again. The solution should then remain in the bladder for two hours. Please note the following:

1) Do not drink too much fluid before the planned BCG treatment so that you do not have to go to the toilet for two hours after the solution has been introduced.
2) Empty the bladder (if possible two hours after the treatment) while sitting and avoid splashing urine drops.
3) Wash your hands thoroughly afterwards.
4) After emptying your bladder, drink plenty of fluids so that the bladder is flushed out.
5) Unprotected sexual intercourse should be avoided for one week after treatment.

Duration of use
6 BCG treatments will be carried out at weekly intervals as long as you can tolerate the treatment. Further BCG treatments can be recommended every quarter or every six months, depending on the course of the disease.

Check-ups
In superficial bladder cancer, the most common control examinations are cystoscopy and urine examinations for altered cells. Such check-ups are usually carried out at quarterly intervals. Your doctor will suggest a follow-up schedule with appropriate time intervals.

When should BCG treatment be avoided?
BCG therapy is out of the question,

1) if you have tuberculosis.
2) if there is a disease of the immune system or an immune deficiency (e.g. positive HIV test).
3) if treatment with immunosuppressive substances (substances that weaken the body’s immune system, e.g. after organ transplants), chemotherapy or cortisone preparations is carried out at the same time.
4) during pregnancy and breastfeeding.

Which side effects can occur?
In general, BCG therapy is well tolerated. Because the BCG treatment causes local inflammation in the bladder, as already mentioned, typical symptoms of bladder inflammation can occur as a result of the treatment (increased urination, pain in the bladder area, burning sensation in the urethra), but these should subside within 48 hours . Slight increases in body temperature (<38.5 ° C), flu-like symptoms and malaise are frequent following the BCG treatment and are part of the effect of the therapy, but these symptoms also subside within 48 hours.

When should your doctor be informed?
If you have any of the following symptoms, you should inform your doctor.

Local side effects
In individual cases, blood may temporarily be present in the urine, which should be reported to your doctor. If you notice it is difficult to urinate, it may be a rare inflammation of the prostate. You should also inform your doctor here. Inflammatory swellings of the testicles and epididymis are occasionally possible and also require immediate contact with a doctor.

General side effects
Reddening of the skin, joint pain or inflammation of the joints occur occasionally. They may be due to an allergy to BCG or components of the irrigation solution and may require you to stop BCG therapy. If febrile temperatures above 38.5 ° C (measured in the rectum), severe symptoms of illness or organ complaints last longer than 48 hours, immediate medical treatment is necessary. With this rare complication, BCG bacteria may have entered the bloodstream and therapy with tuberculostatic antibiotics may be necessary.

Document for download

Information BCG.pdf (pdf, 1137 KB)