BCG Treatments - Bacteria in my urine

Posted by caflynnr1 @caflynnr1, Feb 21 2:19pm

I was diagnosed with Stage 1 High Grade Bladder Cancer in October, found by accident after a CT scan was done upon having a Diverticulitis attack and no knowing what it was. (New diagnosis)

I have had 4 of my 6 BCG treatments to date. The side effects have been minimal thankfully. But every time I go in and provide a Urine sample there is a lot of bacteria in my urine. I had to forgo 2 treatments because the culture appeared to show an infection was present, but then after 3 full days of waiting, the culture showed there was no infection, just a lot of bacteria.

Does anyone have any ideas on how to lower the bacteria in my bladder? I have been taking 3 Probiotic pills a day along with 2 Cranberry Supplements, drinking a lot of water for the past month but the level seems to remain the same. I am told there is no medication to reduce the bacteria.

Anyone else experience this?

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Welcome to Connect @caflynnr1. I am sorry that I don't have a good solution for your high bacterial count in your urine. As a veterinarian, we run into high bacterial counts in cats and dogs. As in your case, if the urine microscopic exam and culture do not indicate infection, and there are no symptoms, then no treatment is done. Perhaps a discussion with your doctor about a urinary antiseptic like Nitrofurantoin might be helpful? There are a lot of different herbal supplements that are thought to focus on bladder health besides cranberry juice and perhaps further research is indicated. Then a discussion with your oncologist or urologist about safe use during BCG treatment.

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@sepdvm

Welcome to Connect @caflynnr1. I am sorry that I don't have a good solution for your high bacterial count in your urine. As a veterinarian, we run into high bacterial counts in cats and dogs. As in your case, if the urine microscopic exam and culture do not indicate infection, and there are no symptoms, then no treatment is done. Perhaps a discussion with your doctor about a urinary antiseptic like Nitrofurantoin might be helpful? There are a lot of different herbal supplements that are thought to focus on bladder health besides cranberry juice and perhaps further research is indicated. Then a discussion with your oncologist or urologist about safe use during BCG treatment.

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Thanks for responding Sue. I have searched exhaustingly about this issue and asked my Nurse at the Urologist's office, and they have no suggestions. I am finding this office to not be very helpful in most regards sadly. Once my treatments are done I will be seeking another Urologist, this lack of information is ridiculous!

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Update: My Dr has left the practice...it's a sign.

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Another update: I met with the new Dr assigned to me when my old Dr left. Although I only have 2 BCG treatments left, she is going to prescribe a low dose antibiotic to take until I am done to make sure I don't have another UTI causing me to delay treatment.

Sure wish that happened when I first started treatments upon asking the Nurse giving me my treatments what I could do to reduce the Bacteria in my urine. The antibiotic won't help the bacteria but should avoid getting any more UTI's the next few weeks.

So, if someone has an issue and has my same question regarding delayed BCG treatments, they might want to consider asking the Dr directly what can be done and ask about a low dose antibiotic for the 6 weeks.

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Unfortunately, UTI's are expected as a side effect of BCG. If you do not show blood in your urine, you should proceed. Your medical providers should be aware that antibiotics will reduce the efficiency of BCG induction. My BCG induction was delayed by only one week for the entire protocol, meaning that I had the six full-dose BCG induction in 7 weeks. A urinalysis was done before each treatment, and regardless of the presence or not of bacteria if I was not showing any symptoms, the induction was done.

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@vickyhay

Unfortunately, UTI's are expected as a side effect of BCG. If you do not show blood in your urine, you should proceed. Your medical providers should be aware that antibiotics will reduce the efficiency of BCG induction. My BCG induction was delayed by only one week for the entire protocol, meaning that I had the six full-dose BCG induction in 7 weeks. A urinalysis was done before each treatment, and regardless of the presence or not of bacteria if I was not showing any symptoms, the induction was done.

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The organism in the BCG is affected by some antibiotics, but not all in what I have researched. Perhaps the medical providers know which drug is safe to use during this treatment? Also perhaps the risk of reducing treatment efficacy is less than the risk of delaying more instillation treatments? Just food for thought as I don't have the answers to these questions. Perhaps @caflynnr1 can have this discussion with her provider.

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@sepdvm

The organism in the BCG is affected by some antibiotics, but not all in what I have researched. Perhaps the medical providers know which drug is safe to use during this treatment? Also perhaps the risk of reducing treatment efficacy is less than the risk of delaying more instillation treatments? Just food for thought as I don't have the answers to these questions. Perhaps @caflynnr1 can have this discussion with her provider.

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My source --

Front Oncol. 2021; 11: 570077.
Published online 2021 Apr 2. doi: 10.3389/fonc.2021.570077
PMCID: PMC8051584
PMID: 33868985

Association Between Antibiotic Treatment and the Efficacy of Intravesical BCG Therapy in Patients With High-Risk Non-Muscle Invasive Bladder Cancer
Sahyun Pak, 1 , 2 Sun-Young Kim, 3 Sung Han Kim, 1 , 4 Jae Young Joung, 1 Weon Seo Park, 5 Jinsoo Chung, 1 Kang Hyun Lee, 1 and Ho Kyung Seo 1 , 4 , *

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@vickyhay

Unfortunately, UTI's are expected as a side effect of BCG. If you do not show blood in your urine, you should proceed. Your medical providers should be aware that antibiotics will reduce the efficiency of BCG induction. My BCG induction was delayed by only one week for the entire protocol, meaning that I had the six full-dose BCG induction in 7 weeks. A urinalysis was done before each treatment, and regardless of the presence or not of bacteria if I was not showing any symptoms, the induction was done.

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I am aware UTI's are more prevalent with BCG treatments. My concern was over the delays in treatment due to bacteria in my urine, having to wait 4 days for the culture to grow to only be told there was no UTI and the risk the delay has on Cancer entering the muscle.

Thank you for your insight, however. Apparently, each office has their own protocol for how the initial urinalysis is read. Mine appears to be very conservative, sounds like yours was not.

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@caflynnr1

I am aware UTI's are more prevalent with BCG treatments. My concern was over the delays in treatment due to bacteria in my urine, having to wait 4 days for the culture to grow to only be told there was no UTI and the risk the delay has on Cancer entering the muscle.

Thank you for your insight, however. Apparently, each office has their own protocol for how the initial urinalysis is read. Mine appears to be very conservative, sounds like yours was not.

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I understand your concern @caflynnr1. This is one of those circumstances where the judgment of our medical providers is so important. They are likely weighing the risks of delay with the risks of continuing treatment during a true UTI. We have to hope they make the best decision for our care. Unfortunately medicine is not always black and white, but frequently shades of gray, so personal opinion, past experience, conservative vs aggressive practice style all come into play as well. Please keep us updated as you continue your treatment.

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@vickyhay

My source --

Front Oncol. 2021; 11: 570077.
Published online 2021 Apr 2. doi: 10.3389/fonc.2021.570077
PMCID: PMC8051584
PMID: 33868985

Association Between Antibiotic Treatment and the Efficacy of Intravesical BCG Therapy in Patients With High-Risk Non-Muscle Invasive Bladder Cancer
Sahyun Pak, 1 , 2 Sun-Young Kim, 3 Sung Han Kim, 1 , 4 Jae Young Joung, 1 Weon Seo Park, 5 Jinsoo Chung, 1 Kang Hyun Lee, 1 and Ho Kyung Seo 1 , 4 , *

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Thank you for sharing this. I would love to read it. The more we know, the better our decision making is.

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