Bacillus Calmette Guerin (BCG) Treatment for Non-Muscle Invasive Bladder Cancer


What is BCG (Bacillus Calmette-Guerin) treatment for non-muscle invasive bladder cancer?

BCG (bacillus Calmette-Guerin) is an intravesical immunotherapy using a bacteria of Mycobacterium bovis (bovine TB) that has been reduced to cause less harm to the body. The bacteria is still kept viable (or "live") so that it can actively work in the body to kill the cancer cells.

Intravesical is a way in which a medication is put into the bladder. Liquid drugs are put directly into the bladder through a catheter.

BCG is used as a therapy for and protection against bladder cancers that come back after a period of time in patients that have a more aggressive bladder cancer diagnosis. It is currently the most effective treatment.

Procedure Details

What do I need to know to prepare for BCG treatment?

  • Restrict your fluid intake, caffeinated beverages and use of diuretics (water pills) 4 hours prior to procedure if possible.
  • Do not void (urinate) for 1 to 2 hours after the procedure, if possible.

    After your first urination following the procedure and for six hours afterward, you will be asked to follow these instructions:

  • Sit to void to avoid urine splashing. Do not use public toilets or void outside.

  • After each void add 2 cups undiluted bleach to toilet, close the lid and wait 15-20 minutes and then flush the toilet. Repeat with each void for 6 hours.
  • Increase fluid intake to dilute the urine. Begin after the first void post procedure.
  • If you are sexually active, wear a condom with intercourse throughout the entire treatment course.
  • If you have urinary incontinence, immediately wash clothes in clothes washer. Do not wash with other clothes.
  • If wearing incontinence pad, pour bleach on pad, allow to soak in, then place in plastic bag and discard in trash.
  • Call urology clinic or provider if chills, severe shivering and fever over 101.3°F (38.5°C) develop.
  • Acetaminophen or ibuprofen may be used for fever and body aches.
  • You may need antispasmodic medication to help with frequency and urgency.

Risks / Benefits

What are potential side effects and complications of BCG treatment?

Benefits of this treatment outweigh risks and side effects.

Common side effects within 24 hours post procedure that do NOT need a phone call to the office include:

  • Small amount of blood in urine
  • Low grade fever (99-100°F)
  • Tiredness
  • Urinary frequency, urgency and burning with urination
  • Muscle or joint achiness

You will be given prescriptions to address the urinary symptoms if needed. You will be able to treat fever with over-the-counter pain/fever medication.

Other less common to rare side effects (some may require call to physician’s office):

  • Skin rash/ eruptions
  • Fever greater than 101.3°F
  • Nausea/vomiting/anorexia (lack appetite)
  • Urinary incontinence
  • Bladder spasms
  • Blood in urine with inability to pass urine due to clots
  • Urinary tract infection
  • Inflammation in testicle/scrotal region
  • Abscess formation
  • Ureteral obstruction
  • Bladder contracture/necrosis (cell death)
  • BCG sepsis
  • Neutropenia (low count of white blood cells that fight off infection)
  • Tissue necrosis with leakage of fluid
  • Pneumonitis
  • Hepatitis

Intravesical BCG is contraindicated (should not be used) with the following conditions:

  • Within 7 to 14 days of bladder or prostatic surgery, including biops
  • Within 7 to 14 days following traumatic catheterization
  • Traumatic catheterization or blood in urine day of treatment
  • Pregnant or nursing patients
  • Patients with active tuberculosis
  • Immunosuppressed patients with congenital or acquired immune deficiency. If treatment is still deemed necessary, informed consent must be discussed by prescribing provider and documented in patient's record.
  • Symptomatic urinary tract infection: Severe burning on urination; foul-smelling urine; fever/chills; or if you have had urinary tract infection and experience similar symptoms
  • In the presence of illness with fever
  • Patients on treatment with certain antibiotics that may interfere with effectiveness of BCG (discuss with prescribing or collaborating provider before administration)
  • Any previous allergies or adverse reactions to BCG
  • Patients unable to retain solution in bladder for desired indwelling time
  • Taking antibiotics with a name ending in “–floxacin”

Last reviewed by a Cleveland Clinic medical professional on 07/23/2018.


  • American Urological Association. Intravesical Administration of Therapeutic Medication. ( Accessed 7/27/2018.
  • American Cancer Society. Intravesical Therapy for Bladder Cancer. ( Accessed 7/27/2018.
  • U.S. National Library of Medicine. Bacillus Calmette-Guerin (BCG) Vaccine. ( Accessed 7/27/2018.

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