This information explains intravesical (IN-truh-VEH-sih-kul) therapy at MSK. It also explains what to expect before and during your intravesical therapy treatments.
About Intravesical Therapy
Intravesical therapy treats cancer in the bladder or urothelium (yoo-roh-THEE-lee-um), the lining of the bladder and urinary tract. Intravesical therapy is used to treat cancer that has not spread outside the bladder’s lining.
Figure 1. Your bladder and urothelium
During intravesical therapy, your healthcare provider will inject (put) medication into your bladder through a catheter (thin, flexible tube) in your urethra. The medicine makes the bladder’s inner lining break away from the layers of tissue under it. The lining is then carried out of your bladder by your urine when you urinate (pee). This gives your bladder a chance to grow a new lining that does not have cancer cells.
Each injection (shot) is 1 intravesical treatment. Your healthcare provider will talk with you about your intravesical therapy treatment schedule.
During your intravesical therapy
During this treatment, you must take some safety steps. It’s important for you or your partner to use a barrier (such as a condom or dental dam) during sexual activity (having sex). This helps keep your partner safe from the intravesical therapy medicine.
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 medicine.
Before each intravesical treatment appointment
Intravesical therapy medicine works best if there’s not much urine in your bladder. You must hold the medicine in your bladder for a certain amount of time. It will not work as well if your bladder fills with urine, or you must urinate before the treatment ends.
Follow the guidelines below on the day of your treatment. This will help your body make less urine.
If you take a diuretic (water pill), do not take it before your appointment. You can take it after your treatment, if needed. Take your other medicines at your normal time.
Starting 4 hours before your appointment:
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Do not drink anything. If you need help swallowing your medicines, it’s OK to take them with a small sip of water.
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Do not eat anything with caffeine (such as chocolate or foods made with coffee). You can eat foods that do not have caffeine.
Your healthcare provider may tell you to take a medicine before each of your treatments. If they do, follow the instructions they give you.
Getting the intravesical therapy medicine
Your intravesical treatment appointments will be in the infusion treatment area. When you arrive for your appointment, check in at the reception desk.. Have a seat in the waiting area.
A member of your care team will ask you to urinate before you get the medicine. Try to empty your bladder all the way. Once your bladder is empty, your healthcare provider will place a catheter through your urethra into your bladder.
They’ll inject the intravesical therapy medicine into your bladder through the catheter. You may have a feeling of fullness in your bladder, but not any pain. After the injection, 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 when something is not sexual. This includes when a healthcare provider handles your penis to place or remove a catheter.
Reflex erections are normal and do not mean you’re aroused (turned on). They will not affect the treatment or your care. Take a few deep breaths or think of something else. It can help your erection go away.
During each intravesical treatment
For each treatment, you’ll hold the medicine 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 medicine is put into their bladder. 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 medicine is in your bladder, you can do all your normal activities. You do not need to do any special activities or movements. For example, you do not need to lay down or move from side to side for the medicine to work.
Emptying your bladder
When your treatment time is up, urinate to let the medicine 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 these 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 2 times.
- 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. There may only be 1 bathroom. If so, keep disinfecting sanitizing wipes near the toilet to clean the toilet seat and rim after each use. After 48 hours (2 days), wash the toilet and bathroom floor.
After you urinate, wash your hands and genital area well. This will help keep your skin from getting irritated.
- Use soap and warm water or moistened wipes, such as baby wipes. Wipe your perineal area (between your legs) and upper thighs.
- If any liquid gets on your skin when you urinate, wash the area with soap and warm water.
- Wash your hands with soap and warm water.
At your next appointment, tell your healthcare provider how long you held the medicine 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).
After each treatment, unless your healthcare provider gives you other instructions, you can go back to your normal activities right away.
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 medicine 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 treatments. Your healthcare provider will tell you when to schedule them.
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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.
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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.