John J. Bauer, M.D., F.A.C.S.
Counseling and Pre-Op Note (Risks)
Instillation of Medication into the Bladder
Procedure: Intravesical Therapy For Bladder TCCA
Recurrent superficial bladder transitional cell carcinoma
Options include repeat transurethral resection without IV therapy. Options for agents are: BCG, Thiotepa, Mitomycin C, Adriamycin, Interferon Alpha 2b, and BCG/IFN combination.
The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, infection, fever and chills, bladder pain, dysuria, failure of the procedure, potential injury to other surrounding structures, all the agents have the possibility of immuno- suppression could lead to fulminating infections and death. Additional procedures will be necessary.
The specific risks of this procedure include, but are not limited to: if BCG is used then possible systemic infection with the active TB bovis agent which may require cessation of therapy, INH therapy, or admission to the hospital for IV antibiotics, lymph node disease with TB bovis, extensive lung disease if not treated adequately, possible long- term ICU stay, and death. Liver damage could also occur with this agent.
You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.
Physician's Signature: ________________________________ Date: __________________
Patient Signature: __________________________________ Date: __________________
You are about to receive medication into your bladder. This is done by inserting a catheter into the opening of the urethra, then into the bladder. When the catheter is passed into the bladder, the medicine will be passed through the catheter into the bladder. This is called bladder instillation. You will receive your treatment via this method. The usual course of treatment is once a week for six weeks and after a three-week break an additional 3 treatments will be required.
Please be on time for your appointment.
Do not drink fluids for at least 4 hours before you receive your treatment.
Inform your doctor if you felt feverish, tired or had chills since your last treatment or if you have been urinating any bright red blood before your instillation.
Empty your bladder just before the instillation.
The medication will be instilled into your bladder through the catheter.
In most cases, the catheter will be removed from the bladder after the instillation.
The medication should be retained for at least 15 minutes to obtain the best results.
You may be positioned from side to side and back to front while the medication is still in your bladder.
Now that you have retained the medication in your bladder for al least the past 15 minutes, you must know several things:
Sit down on the toilet to urinate and fully empty your bladder.
After urinating, pour two cups of household bleach (Clorox or equivalent) into the toilet.
Let the medication and Clorox mixture stay in the toilet for 15-20 minutes before flushing.
Repeat the above process each time you urinate for six hours after each treatment.
Wash your hands and genital areas thoroughly after you urinate.
Drink plenty of fluids after your instillation to flush your bladder.
Until Your Next Instillation
You may experience some burning with the first void after your treatment. If this occurs, you need to increase your fluid intake.
If you experience continued pain or burning on urination or you experience:
- Bright red blood or blood clots in the urine
- Joint pain
- Skin rash
CALL YOUR DOCTOR !
If you experience:
- Malaise (feeling of discomfort)
- Increased fatigue
- Flu-like symptoms
CALL YOU DOCTOR !