About Intravesical Therapy

This information explains intravesical (IN-truh-VEH-sih-kul) therapy at MSK. It also describes what to expect before and during your intravesical therapy treatments.

About Intravesical Therapy

Intravesical therapy is a type of treatment for cancer in your bladder or urothelium. Your urothelium is the cells that line your bladder and urinary tract. Intravesical therapy is used to treat cancer that hasn’t spread outside the lining of your bladder.

During intravesical therapy, your healthcare provider will inject (put) medication into your bladder through a catheter (thin, flexible tube) in your urethra. The medication causes the inner lining of your bladder to break away from the layers of tissue underneath. The lining is then carried out of your bladder in your urine when you urinate (pee). This gives your bladder a chance to grow a new lining that doesn’t have any cancer cells.

Each injection is 1 intravesical treatment. Your healthcare provider will talk with you about your intravesical therapy treatment schedule.

During your intravesical therapy

During your intravesical therapy, it’s important for you or your partner to use a barrier (such as a condom or dental dam) during sexual activity. This will help you avoid exposing your partner to intravesical therapy medication. Start using barriers when you start intravesical therapy. Your healthcare provider will tell you when it’s safe to stop using them. 

Before your treatment, your healthcare provider will give you more instructions based on the intravesical therapy medication you’ll be getting. 

Before each intravesical treatment appointment

Intravesical therapy medications work best if there’s not much urine in your bladder. You’ll also need to hold the medication in your bladder for a certain amount of time. If your bladder fills with urine or you need to urinate before your treatment is finished, the medication won’t work as well.

Follow the guidelines below on the day of your treatment appointments. This will help your body make less urine before your treatments.

If you take a diuretic (water pill), don’t take it before your appointment. You can take it after your treatment if needed. Take your other medications at your normal time.

Starting 4 hours before your appointment:

• Do not drink anything. If you need help swallowing your medications, it’s OK to take them with a small sip of water.
• Do not eat anything with caffeine (such as chocolate or foods made with coffee). You can eat foods that don’t have caffeine.

Your healthcare provider may tell you to take a medication before each of your treatments. If they do, follow the instructions they give you.

Getting the intravesical therapy medication

Your intravesical treatment appointments will be in the infusion treatment area. When you arrive for your appointment, check in at the reception desk and have a seat in the waiting area.

A member of your care team will ask you to urinate before you get the medication. Try to empty your bladder completely. Once your bladder is empty, your healthcare provider will place a catheter through your urethra into your bladder. They’ll inject the intravesical therapy medication into your bladder through the catheter. You may have a feeling of fullness in your bladder, but you won’t have any pain. After they inject the medication into your bladder, they’ll remove the catheter. 

Reflex erection

A reflex erection is when your penis gets hard when someone or something touches it. Reflex erections are involuntary (not on purpose). They can happen in non-sexual situations, such as when a healthcare provider is handling your penis to place or remove a catheter. Reflex erections are normal and don’t mean you’re aroused (turned on).

Getting a reflex erection while you’re getting the intravesical therapy medication won’t affect your care. Taking a few deep breaths or thinking of something else can help your erection go away.

During each intravesical treatment

For each treatment, you’ll hold the medication in your bladder for 1 to 2 hours. Your healthcare provider will tell you the exact length of time. It may not be the same for each treatment.

Most people can go home after the medication is put into their bladder, but some people may need to stay in the clinic area for up to 2 hours. Your healthcare provider will give you more instructions during your appointment.

While the intravesical therapy medication is in your bladder, you can do all your normal activities. You don’t need to do any special activities or movements (such as lying down and moving from side to side) for the medication to work. 

Emptying your bladder

When your treatment time is up, urinate to let the medication out of your bladder. Empty your bladder completely.

You may need to take special steps each time you urinate for the first 6 hours after you first urinate. Your healthcare provider will tell you which of the following steps to follow. You may not need to follow all of them.

• Sit on the toilet when you urinate. This helps prevent splashing.
• After you urinate, pour 1 cup of bleach into the toilet. Leave it in the toilet for 15 minutes, close the toilet lid if there is one and flush twice.
• Clean up body fluid spills with 2 pairs of gloves and disinfectant sanitizing wipes.
• If available, use a separate toilet from family members for 48 hours (2 days) after the first urination. If the household only has one bathroom, keep disinfecting sanitizing wipes near the toilet to clean the toilet seat and rim after each use. After the 48 hours (2 days), the toilet and bathroom floor should be washed. 

• Wash your hands with soap and warm water.

At your next appointment, tell your healthcare provider how long you held the medication in your bladder before urinating.

After each intravesical treatment

For 48 hours (2 days) after each treatment, drink more liquids than usual. Aim for 8 or more (8-ounce) glasses of liquids each day. Avoid alcohol and liquids with caffeine (such as coffee, tea, and cola).

You can go back to doing your other usual activities right away after each intravesical treatment unless your healthcare provider gives you other instructions.

Side effects

After each intravesical treatment, you may:

• Have discomfort or a burning sensation when you urinate.
• Need to urinate more often than usual.
• See light red or pink blood in your urine.
• See small pieces of scabs or small amounts of bladder lining in your urine.

Some intravesical therapy medications may cause other side effects. Your healthcare provider will tell you about any other side effects you may have.

If you need help managing any side effects, call your healthcare provider.

Response to intravesical therapy

During or after your intravesical therapy, you’ll have tests to see how you’re responding to the treatments. Your healthcare provider will tell you when to schedule them.

• You’ll have a cystoscopy to check your bladder. During the cystoscopy, your healthcare provider will insert a cystoscope (long, thin camera) through your urethra into your bladder.
• You’ll give a urine sample for urine cytology (a urine test). The test will check for cancer cells in your urine.

Based on these tests, your healthcare provider will tell you when to schedule your next follow-up appointment.

When to call your healthcare provider

Call your healthcare provider if you have:

• A fever above 100.5 °F (38 °C).
• Shaking, chills, or both.
• Bright red blood or clots in your urine. Blood clots are large, red, sometimes stringy clumps of blood.
• Flu-like symptoms lasting more than 2 days.
• Fatigue (feeling more tired than usual).
• A rash on your skin.
• A cough.
• Burning or pain during urination for more than 3 days.
• Trouble urinating or can’t urinate.