I believe that you probably had TURB's, rather than cystoscopy? Cystoscopy involves the urologist using a very small camera to look inside the bladder, while TURB (transurethral resection of the bladder) is done under anesthetic so that biopsy sample can be removed and sent to the pathologist for analysis. It is NOT uncommon for bleeding to occur after a TURB....after all, pieces of the bladder were cut out. And an anti-coagulant would increase the odds of this.
We are not doctors here, just patients and families of patients like yourself. Your questions about anticoagulant use need to be addressed with your urologist asap since any changes would need to be made quite a while before further treatment.
As for BCG, first the urologist always checks urine prior to instillation. If there is any blood or infection present, they will not administer BCG until it is resolved. And since in your case the tumors have returned, a totally new series of 6 BCG instillations would be indicated; maintenance (3 treatments every three months) is used when there is no evidence of a return, to insure that it does not come back.
It is important for you to discuss the situation with regard to your anticoagulant use with your urologist. In addition, if the side effects of the BCG are too much to bear, the dose can be reduced significantly with no apparent loss of effectiveness. You need to discuss this with your doctor.
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
I was diagnosed with bladder cancer in December 2016. I have had a total of three cystoscopies since then involving resection of a number of non-invasive high grade carcinomas. April twenty-sixth was the last cystoscopy. Inflammation was noted in the dome of the bladder. (Possibly from the previous initial series of six BCGs.) Five specimens were taken from various locations. Of significance was a 4-5 mm tumor in the posterior lateral section of the bladder neck. It was looped out with a resectoscope and ultimately diagnosed as a non-invasive high grade papillary carcinoma. Following the procedures Mitomycin C was instilled.
It has been four and a half weeks since the cystoscopy and blood is still evident in my urine. A urinalysis last week found no infection, but blood was evident at a level 2. We have temporarily put off the next round of BCGs till next week pending bleeding.
I have a number of concerns: 1. I have been told that bleeding up to six weeks following a cystoscopy is not uncommon. True? (I am on 20 mg Xarelto (Due to a single episode of bilateral pulmonoary embolisms in November 2015.) 2. Should I be worried about the injection of BCG if I am either bleeding a few days before BCG or post BCG? 3. Originally, the plan was to do a series of 3 BCGs (Following the initial series of six) . Now, I am told that the Urologist wants me to go through a series of six again (which I do not tolerate very well...putting it mildly). Is there any clinical justification for going through another series of six...or does three suffice? 4. Should I go off of Xarelto for a period of time when blood is detected (potentially putting me at risk for a blood clot) or drop back to a lower does of Xarelto or consider a different blood thinner such as Pradaxa or Eliquis?
Thanks for any advice on the above. Jim