What are the alternatives to intravesical BCG therapy?

The choice depends on whether the bladder tumour is high risk, whether it has returned, how it responded to BCG, and whether there is evidence of invasion. A urology team may discuss changing the medicine placed into the bladder, repeating an appropriate bladder treatment, or using surgery. Bladder removal surgery removes the bladder and requires a new way for urine to leave the body. The decision is different for non-muscle-invasive and muscle-invasive bladder cancer.

The wider diagnosis matters too. You can read about [Bladder Cancer](/conditions/bladder-cancer/) and the treatment itself at [Intravesical BCG Therapy](/treatments/systemic-therapy/intravesical-bcg-therapy/). [BCG Solution](/materials/bcg-solution/) explains the medicine used in this approach.

Ask for the pathology report, including tumour grade, stage and whether muscle is involved. Bring a list of previous bladder treatments, side effects, urinary symptoms and other medicines. Your team may use cystoscopy, urine tests or scans to check what is happening before recommending an alternative. Ask how each option affects bladder function, follow-up cystoscopies, recovery and the possibility of needing further treatment.

Contact your urology team promptly for visible blood in the urine, worsening difficulty passing urine, fever, chills or severe pelvic pain. Seek urgent help if you cannot pass urine, feel faint, or become acutely unwell. These symptoms need assessment regardless of which bladder treatment you are considering.

What is the stage and grade of my tumour? Why are you recommending this alternative? Would bladder removal surgery be appropriate, and what urinary diversion would it involve? How will we monitor the bladder after treatment?