I really don't worry about "holding" the BCG much over an hour since my second maintenance. Since I have had three maintenance, the side effects get stronger every time. As for the reduced dosage quoted from Dr Lamm "When patients begin to have increased symptoms following BCG instillation, the dose can be reduced to 1/3, 1/10, or 1/100th as needed to prevent significant side effects with subsequent treatment. Never give BCG if symptoms from previous BCG administrations are still present, and never instill BCG if the catheterization is traumatic or bloody. Nothing is lost by postponing BCG treatment if patients have symptoms, because symptoms are evidence of continued immune stimulation. Excess BCG administration is associated with increased side effects and suppression of antitumor immune response."
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