The rigid cystoscope is passed through the urethra into the bladder so the surgeon can see the inside of your bladder on a monitor. The surgeon may remove the tumour through the urethra using a wire loop on the end of the cystoscope. Other methods for destroying the cancer cells include burning the base of the tumour with an electrical current (fulguration) or a high-energy laser.

If the cancer has spread to the lamina propria or is high grade, you may need a second TURBT 2–6 weeks after the first procedure to make sure that all cancer cells are removed. If the cancer comes back after initial treatment, your surgeon may do another TURBT or suggest removing the bladder in an operation known as a cystectomy.

• Most people who have a TURBT stay in hospital for 1–2 days. Your body needs time to heal after the surgery.
• You may have a thin, flexible tube (catheter) in your bladder to drain your urine into a bag. The catheter may be connected to a system that washes the blood and blood clots out of your bladder (bladder irrigation). When your urine looks clear, the catheter will be removed and you will be able to go home. If the tumour is small, there may be no need for a catheter and you may be discharged from hospital on the same day. 
• Side effects may include blood in the urine, needing to pass urine more often and bladder infections. It is normal to see some blood in your urine for up to two weeks. Your doctor may prescribe antibiotics to prevent infection.
• It is important to keep drinking lots of water to flush the bladder and keep the urine clear.
• When you go home, avoid any heavy lifting, vigorous exercise or sexual activity for 3–4 weeks.
• Contact your medical team promptly if you feel cold, shivery, hot or sweaty, have burning or pain when urinating, need to urinate often and urgently, pass blood clots or have difficulty passing urine.

Because intravesical chemotherapy puts the drugs directly into the bladder, it has fewer side effects than systemic chemotherapy (when the drugs reach the whole body).

The main side effect is bladder inflammation (cystitis). Signs of cystitis include wanting to pass urine more often or a burning feeling when urinating. Drinking plenty of fluids can help. If you develop a bladder infection, your doctor can prescribe antibiotics.

In some people, intravesical chemotherapy may cause a rash on the hands or feet. Tell your doctor if this occurs. While you are having a course of intravesical chemotherapy, your doctor may advise you to use contraception.

Your treatment team will tell you what safety measures to follow after you go home. This is because BCG is a vaccine that contains live bacteria, which can harm healthy people.

• For the first six hours after BCG treatment, sit down on the toilet when urinating to avoid splashing. When finished, pour 2 cups of household bleach (or a sachet of sodium hydrochlorite if provided by your treatment team) into the toilet bowl. Wait 15 minutes before flushing with the toilet lid closed.
• If any clothing is splashed with urine, wash separately in bleach and warm water.
• If you use incontinence pads, for a few days after treatment take care when disposing of them. Pour bleach on the used pad, allow it to soak in, then place the pad in a plastic bag. Tie up the bag and put it in your rubbish bin. You may also be able to take the sealed bag back to the hospital or treatment centre for disposal in a biohazard bin.
• For a few days after each treatment, wash your hands extra well after going to the toilet, and wash or shower with soap and water if your skin comes in contact with urine.
• Drink plenty of liquids for 6–8 hours after treatment.
• For a week after each treatment, use barrier contraception (condoms) to protect your partner from any BCG that may be present in your body fluids and to prevent pregnancy.
• Speak to your medical team if you have any questions.

For most people with high-risk non-muscle invasive bladder cancer, the initial course of six BCG treatments is followed by what is known as maintenance BCG.

Maintenance treatment with BCG reduces the risk of the disease coming back or spreading. Maintenance treatment can last for 1–3 years, but treatment sessions become much less frequent (e.g. one dose a month). Treatment schedules can vary so ask your doctor for further details.

Common side effects of BCG include:

• needing to urinate more often
• burning or pain when urinating
• blood in the urine
• a mild fever
• tiredness.

These side effects usually last a couple of days after each BCG treatment session. Less often, the BCG may spread through the body and can affect any organ. If you develop flu-like symptoms, such as fever over 38°C that lasts longer than 72 hours, pain in your joints, a cough, a skin rash, tiredness, or yellow skin (jaundice), contact a nurse or doctor at your treatment centre immediately. A BCG infection can be treated with medicines.

Very rarely, BCG can cause infections in the lungs or other organs in the body months or years after treatment. If you are diagnosed with an infection in the future, it is important to tell the doctor that you had BCG treatment.