Intravesical BCG / MMC Treatment

What is this procedure?

Intravesical therapy means that a medication is instilled directly into the bladder through a small catheter. Two agents are used most commonly:

• BCG (Bacillus Calmette-Guérin): A weakened live bacterium that stimulates the immune system to attack residual bladder cancer cells. It is typically given as an induction course of six weekly instillations, often followed by maintenance treatments.
• Mitomycin C (MMC): A chemotherapy agent that destroys cancer cells locally within the bladder. It may be given as a single dose immediately after TURBT, or as a course of weekly instillations.

Both treatments aim to reduce the risk of bladder cancer returning (recurrence) and, in the case of BCG, reduce the risk of it progressing to a more dangerous stage.

Before each instillation

• Do not drink large amounts of fluid for 4 hours before each appointment. A concentrated bladder allows the drug to work most effectively.
• Urine dipstick: A urine test is performed at each visit to check for infection. If an active infection is present, the treatment will be postponed and an antibiotic prescribed.
• Medications: Continue regular medications as normal. Inform the team if you are immunosuppressed or have recently been unwell.
• BCG specifically: Do not have BCG if you are immunocompromised (e.g. receiving chemotherapy, high-dose steroids, or have HIV), as this can lead to serious systemic BCG infection.

What happens during the procedure

A small catheter is passed through the urethra into the bladder using sterile technique. The medication is instilled into the bladder and the catheter is removed. You will be asked to retain the fluid in the bladder for one to two hours, turning position every 15–20 minutes (lying on each side and front/back) to maximise contact of the drug with the entire bladder lining.

After the instillation

• Urination: When you empty your bladder, sit down to urinate for the first void to minimise splash. For BCG: add a large cup of bleach (sodium hypochlorite) to the toilet bowl before flushing and wait 15 minutes. This inactivates the live bacteria and protects others in the household.
• Fluid intake: Drink at least 2 litres of fluid over the rest of the day to dilute the drug and reduce bladder irritation.
• Bladder irritation: Frequency, urgency, and mild burning are common side effects for 24–48 hours after each treatment. This is expected and should settle.
• Sexual activity: Avoid unprotected sex for 48 hours after BCG; the live bacteria can be transmitted. Use a condom. Women who are pregnant or breastfeeding should tell Dr Hadjipavlou before BCG is started.
• Haematuria: Mild blood in the urine can occur and is usually harmless for 1–2 days.

When to seek medical help

Contact the secretary on 22 444 444 or El Greco Medical Centre +357 22 782 000 if you experience:

• Fever above 38.5 °C or persistent flu-like symptoms lasting more than 48 hours after BCG (possible BCG-itis — requires urgent treatment)
• Inability to pass urine
• Severe systemic illness: joint pains, skin rash, persistent high fever, eye inflammation
• Heavy persistent bleeding

Attend the nearest Accident & Emergency department immediately if you feel acutely unwell — inform the team you have had BCG instilled recently.