BCG Patient Information

What is BCG?

BCG (Bacillus Calmette-Guerin) is a weakened bacteria first created as a vaccine for tuberculosis. Although BCG is ineffective as a vaccine, it can stimulate your immune system and help your body fight bladder cancer. There are a number of reasons your doctor may choose to give you BCG. It is used to decrease the chance of having another bladder tumor, prevent the cancer from invading the muscle wall of the bladder, and to cure carcinoma-in- situ. Your urologist can help you understand the reason BCG is appropriate in your case.

How is BCG given?

The standard initial course is one treatment a week for six weeks.  This is called “induction”.  Typically, there is also a maintenance phase where three weekly doses of the BCG are given over the following 1-3 years. The dosage and duration of your treatment may be different as determined by your urologist.  BCG must be given in a doctor’s office or hospital. BCG is a weakened strain of a bacteria. It is important that we minimize any exposure for others who are not receiving this treatment. A bladder catheter is placed each week to put the BCG in the bladder. You will hold the BCG in your bladder for two hours. You must be very careful about where, when, and how you empty your bladder after receiving the BCG. You will see your urologist a number of weeks after the BCG to determine if any other treatment is necessary as well as for surveillance cystoscopy to inspect the bladder.

What are the side effects of BCG?

  • Difficulty urinating
  • Urgency
  • Frequent urination
  • Blood in urine
  • Chills
  • Night sweats
  • Severe sluggishness
  • Persistent fever over 101 F for more than two days
  • Joint pain
  • Cough
  • Skin rash

What should I do if these side effects occur?

  • Avoid caffeine and alcohol.
  • Burning and frequency may get worse during treatment. These symptoms occur because the BCG stimulates your immune system.
  • If fatigue, flu like symptoms or fever: Tylenol will help relieve these symptoms. Drink enough to keep the urine clear. These symptoms occur as BCG stimulates your immune system. Drink plenty of fluid to try to keep the urine yellow to pink in color.
  • Blood in the urine: BCG can cause irritation to the bladder wall and ultimately, bleeding. Bleeding typically resolves.
  • Fever: If temperature over 101 F, chills, rash, prolonged cough or joint pain for more than 48 hours, contact our office as soon as possible. More severe symptoms often indicate a serious reaction to the BCG and may require medication to treat.

What happens on the day I receive BCG?

  • At each visit for the BCG treatment, you will be asked to give a urine sample. This is to be sure you do not have grossly bloody urine or a urinary tract infection. These two things will prevent the BCG from being given that week.
  • An antibiotic may be given to you to take the morning before and the evening after the BCG treatment.
  • A catheter will be placed into your bladder to empty any residual urine and to then instill the BCG medication. This typically takes under five minutes.
  • You can leave immediately after the BCG instillation.
  • The BCG should be left in your bladder optimally for two hours. Ideally, turn ¼ turn every 15 minutes to “coat” the entire bladder. Turn from the back to the right side and then the left side and then the stomach.
  • Urinate after two hours of holding the BCG. If you must urinate before two hours, please let us know at your next visit as to how long you were able to hold the BCG.
  • Men should sit on the toilet to urinate so that the BCG does not splash. Completely empty your bladder. Do not flush the toilet at this point.
  • Wash your hands and genital area with soap and water after urinating.
  • After urinating and washing your skin, pour two cups of bleach (Clorox or equivalent) into the toilet. Let the bleach and BCG stay in the toilet for 20 minutes before flushing. (BCG is a weakened strain of the tuberculosis bacteria. The bleach will kill the bacteria so it does not affect others).
  • Repeat the step with the bleach each time your urinate for the next six hours.

What about sexual relations?

  • Do not have sexual relations for 48 hours after each BCG instillation.
  • Men should wear a condom during intercourse for the entire treatment cycle and for six weeks after the treatment has ended.
  • Women should avoid vaginal contact for one week after each treatment and for six additional weeks after treatment has ended.
  • Remember, BCG is an attenuated (weakened) strain of a bacteria which is why we ask that you take these precautions.

If you have any questions or concerns, please call for further information/instructions.