Intravesical therapy, meaning “within the bladder,” is a medical treatment where a liquid drug is delivered directly into the bladder. Because the treatment is localized, it allows the drug to act on the cells lining the organ while minimizing effects on other parts of the body. This method is distinct from systemic treatments, like intravenous medications, which circulate throughout the bloodstream.
Conditions Treated with Intravesical Therapy
This therapy is a primary treatment for certain types of early-stage bladder cancer. It is used for non-muscle invasive bladder cancer (NMIBC), where the cancer is contained within the bladder’s lining. The goal is to eliminate any remaining cancer cells after a tumor has been surgically removed in a procedure called a transurethral resection of a bladder tumor (TURBT) to lower the risk of the cancer returning.
Two main types of drugs are administered this way for bladder cancer: immunotherapy and chemotherapy. The most common immunotherapy is Bacillus Calmette-Guérin (BCG), a weakened bacterium that stimulates the immune system to attack cancer cells. Intravesical chemotherapy uses drugs like mitomycin C or gemcitabine to destroy cancer cells in the bladder lining.
Beyond cancer treatment, intravesical therapy is also used for other bladder conditions. One notable example is Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). For this condition, a “bladder cocktail,” which is a mixture of medications, may be instilled into the bladder to soothe the lining and reduce pain and inflammation.
The Intravesical Instillation Procedure
Intravesical therapy is typically performed in an outpatient clinic. Before the procedure begins, the patient is asked to empty their bladder completely. A healthcare provider will then apply a local anesthetic to numb the area.
Following this, a thin, flexible tube called a catheter is inserted through the urethra and into the bladder. The liquid medication is then passed through the catheter, and once the full dose has been administered, the catheter is removed.
After the medication is instilled, the patient is instructed to hold the solution in their bladder for a specific period, often one to two hours. During this “dwell time,” the patient may be asked to change positions every 15 minutes to help the drug coat the entire bladder surface.
Post-Procedure Care and Common Side Effects
After the medication’s dwell time is complete, the patient urinates to expel the drug. It is common to experience side effects related to bladder irritation (cystitis), which may include a burning sensation during urination, a more frequent need to urinate, and sometimes blood in the urine.
When Bacillus Calmette-Guérin (BCG) is used, some individuals may also develop mild, flu-like symptoms, such as a low-grade fever, tiredness, or muscle and joint pain. These reactions are temporary, often resolving within a couple of days. Drinking plenty of fluids after the treatment can help lessen these side effects.
Certain precautions may be necessary after receiving treatment to protect others from exposure to the medication. This can include cleaning the genital area after urinating and practicing good hand hygiene. If side effects are severe or do not improve within 48 hours, it is important to contact a doctor.