Ask the Doctor

Spring 2006

We thank Dr. Mark Schoenberg, Professor of Urology and Oncology and Director of Urologic Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medical Institutions for the answers to these questions.

Q. I began bleeding about two or three weeks after I had a TURBT. Is this normal or should I contact my doctor immediately?

A. A small amount of bleeding is not uncommon for two – four weeks following a TURBT. About this time a small scab that has formed at the surgical site falls off, resulting in the bleeding you may see. This is not harmful unless so much bleeding has occurred that it makes normal urination difficult or results in a significant drop in your blood count. If you have difficulty voiding or experience increasing fatigue with the bleeding it is best to let your doctor know immediately.

Q. I’ve noticed that physicians have different opinions about BCG maintenance. Can you explain the pros and cons?

A. Maintenance BCG involves the prolonged administration ofBCG to patients with aggressive superficial bladder tumors who have had a good response to an initial six-week induction course of the medication.

Although the urologic literature contains many maintenance schedules, the schedule outlined in the 2001 publication by Dr. Donald Lamm and colleagues is probably the contemporary standard. According to Dr. Lamm’s protocol, BCG is administered intermittently over 36 months after the initial six week course. Periodic monitoring of the bladder occurs throughout the therapy.

The major difficulty with maintenance is bladder irritation. Only 20 percent of the patients in Dr. Lamm’s study completed the entire course of treatment.

One important caveat: Aggressive superficial tumors can be successfully treated with BCG. However, not all tumors respond to the treatment, and unfortunately some tumors progress. Therefore, it is extremely important to have careful follow-up during maintenance therapy. I suggest a conversation with your physician at the outset of therapy about the appropriate course of action should maintenance therapy fail so that everyone has the same plan and expectations should disease recurrence or progression occur.