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Instillation of BCG vaccine
What does this procedure entail?
This involves the instillation (administration into the bladder) of BCG vaccine in cases with a proven superficial, aggressive tumour of the bladder mucosa or recurrent superficial bladder tumours.
What are the alternatives to this procedure?
An alternative to the above-mentioned procedure recommended by your doctor is the administration of other drugs with the same goal (e.g. drugs with antitumour-cytostatic effects), repeated cystoscopic examination with the treatment of recurrent tumours, bladder irradiation or systemic administration of anticancer drugs (into a vein). Studies have shown better results when BCG vaccine is used in my type of disease. In certain cases, the alternative is to remove the entire bladder and replace it with the intestine (in various variants).
What should I expect before this procedure?
BCG vaccine: These are specially modified, live but weakened tuberculosis microorganisms (Mycobacterium bovis). Tuberculosis microorganisms applied to the bladder elicit a powerful immune response, which improves the defences of the bladder mucosa against bladder cancer.
The purpose of this medical procedure is to prevent the recurrence of the tumour in the bladder mucosa, or at least to delay it. This method requires a diagnosed superficial bladder cancer, but also its type, extent, etc. This method is not suitable and effective in all bladder tumours.
It should be noted that some BCG preparations may react with the influenza vaccine and should not be therefore administered within 6 weeks after vaccination.
Remember to inform your physician about the following possible facts before the submission:
- artificial heart valve
- coronary artery stent
- artificial joint
- artificial vascular graft
- neurosurgical bypass
- other implanted foreign body
- use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
- drug and other allergies
- any abnormalities or eventualities
What will happen during the administration of the BCG vaccine?
To achieve sufficient effectiveness of the treatment, it is recommended to administer it on a long-term basis according to a schedule – one administration is performed every week for the first six weeks. Subsequently, one application is performed weekly for two to three weeks at month 3, 6 and 12. The whole procedure can take up to 3 years. The effect of the treatment (state of the disease) will be monitored via regular cystoscopic examinations. The main reason for the interruption or premature discontinuation of the treatment is usually disease progression or side effects of the treatment (see below).
It is recommended to limit fluid intake on the day of BCG administration – it is necessary to decrease the need to urinate after the administration of the vaccine (the active substance should be kept in the bladder for at least 1 hour (preferably 2 hours) or as recommended by your physician to achieve the optimal effect).
You will undergo urine examination before each administration of the vaccine to rule out any inflammation – if infection tests are positive, the administration will be postponed to after antibiotic treatment.
The administration itself consists of gentle insertion of a thin catheter into the bladder, draining of the rest of the urine and administration of the active substance dissolved in about 50 ml of fluid. After the catheter is removed, you can remain lying in the bed for 60 minutes, so that the active substance comes into contact with the entire bladder. Sometimes the doctor does not insist on this recommendation.
What will happen immediately after this procedure?
After the procedure is completed, you should:
- ask if the planned outcome was achieved
- inform the medical staff about any problems
- ask what you can and cannot do
- ask all the questions you have for the healthcare professionals and members of the medical team.
- remember (and understand) why the procedure was performed, how it turned out, and what will follow
Once the procedure is complete, you will be able to go home.
Try to delay urination as much as possible (at least for one more hour) after leaving the outpatient office. Wash your hands thoroughly after urination (urine contains living microorganisms).
Due to hygienic reasons and the safety for your close ones, sit every time you urinate during the first six hours after receiving the BCG vaccine. Disinfect the urine in the toilet after each use with a disinfectant effective against Mycobacterium bovis, or BCG (e.g. Chloramine B, Chloramix DT, New Cidex, etc.) in the amount and concentration according to the relevant instructions for use. Leave it there for the time specified in the manual, then rinse. Wash your hands with soap and water every time.
We advise against strenuous physical activity for one to two days after the administration; try to get enough fluids (2-3 litres).
Are there any possible side effects?
Most treatment/diagnostic procedures are associated with potential side effects.
Common (10% of procedures of this type)
- Blood in the urine, possibly pieces of tissue in the urine)
- Discomfort when urinating
- Urinary tract infection, which may delay the next dose until after antibiotic treatment
- Flu-like symptoms that may last for 2-3 days
- Frequent and urgent urination – may take 2-3 days
- Failure to complete the entire treatment course due to urinary problems
Occasional (2-10% of procedures of this type)
- Narrowing of the urethra due to repeated insertion of the catheter
- More frequent inflammatory reactions that may affect various parts of the body (e.g. liver, joints, eye fundus)
Rare (may occur in 2% of procedures of this type)
- Persistent or intense pain after treatment, which may require removal of the bladder
- A general and potentially serious infection with BCG bacteria that requires hospital antibiotic treatment. It is not a “classic” TB and there is no risk of getting TB from this treatment.
- MRSA colonisation (0.9% – 1 of 110)
- Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
- MRSA blood infection (0.02% – 1 of 5,000)
Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.
What should I expect when I return home?
When you are discharged from the outpatient office, you should:
- get recommendations on recovery at home
- ask when you can return to normal activities such as work, exercise, driving, cycling, housework and sexual activities
- get a contact number for further questions after returning home or in case of trouble
- ask about the date of the following check-ups and the place where you should come (hospital or your attending physician)
If you have a urinary tract infection (pain when urinating, frequent urination, unusual smell of urine), or high fever with back pain, you should contact your doctor, as your condition may require antibiotic treatment. Likewise, if you are unable to urinate after the examination, you should contact your doctor or urologist immediately.
What else should I watch out for?
Because the medicines are administered directly into the bladder in this case and not into the bloodstream, you will not have side effects associated with other anticancer treatments.
Any important information?
You should wash your hands and genital region after urination.
Men should urinate in a seated position for about 6 hours after the procedure, then they can urinate in standing position.
It is recommended to avoid sexual intercourse for at least 24 hours – it could cause discomfort.
You should use a condom during sexual intercourse during each treatment and for one week after the end of the treatment.
If you are a smoker, you should be aware that smoking increases the risk of bladder tumour recurrence.