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Intravesical BCG Immunotherapy

Direct instillation of bacillus Calmette-Guérin into the bladder for non-muscle-invasive bladder cancer.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Intravesical BCG Immunotherapy?

Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is the cornerstone adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC), particularly carcinoma in situ (CIS) and high-grade Ta/T1 tumors. The therapy follows transurethral resection of bladder tumor (TURBT) and aims to reduce recurrence and progression rates.

Mechanism involves BCG attachment to urothelial cells via fibronectin, internalization, antigen presentation and induction of a Th1-mediated immune response with recruitment of CD4+ T cells, NK cells, neutrophils and macrophages. Cytokines such as IFN-γ, IL-2, IL-12 and TNF-α drive antitumor cytotoxicity.

Standard induction is 6 weekly instillations followed by maintenance therapy (3 weekly instillations at 3, 6, 12, 18, 24, 30, 36 months). Side effects include cystitis, hematuria, low-grade fever, malaise, granulomatous prostatitis, BCG-osis (rare systemic infection) and hypersensitivity. Severe toxicity may require treatment cessation and antitubercular therapy.

Symptoms

Hematuria after TURBT
Recurrent superficial bladder cancer
Carcinoma in situ (CIS)
High-grade Ta/T1 urothelial tumors
Multifocal disease
Post-induction cystoscopic findings
Treatment-related cystitis symptoms

Risk Factors

Tobacco smoking
Occupational chemical exposure (aromatic amines)
Chronic bladder inflammation
Pelvic radiation history
Cyclophosphamide exposure
Schistosomiasis (squamous variant)
Family history of urothelial carcinoma

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent hematuria after instillation
  • High fever (>38.5°C) lasting >24 hours
  • Severe cystitis or pelvic pain
  • Joint pain or systemic symptoms (BCG-osis)
  • Allergic reactions during therapy

Treatment Methods

01
Confirmatory cystoscopy and biopsy after TURBT
02
Restaging TURBT for high-grade T1 disease
03
Standard 6-week induction (BCG-Connaught/TICE/Pasteur strain)
04
Maintenance therapy (SWOG protocol) for high-risk NMIBC
05
Symptomatic management of cystitis (anticholinergics, NSAIDs)
06
Antitubercular therapy for severe toxicity (isoniazid, rifampin)
07
BCG-unresponsive disease: pembrolizumab, intravesical chemotherapy, cystectomy
08
Surveillance cystoscopy every 3 months × 2 years
09
Patient counseling on hygiene during therapy

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.