19 majority of the early literature focused on this delivery device. The safety aspects of the system as well its cost prompted a new approach and the idea of introducing pre-heated chemotherapy to the bladder was considered. I mention two systems below. Their main advantages are that they are easily portable, and they both use disposable systems which realise a relatively cost-effective solution. Combat The Combat system circulates heated drug through the bladder. It heats a uid containing the chemotherapeutic compound in a range of 40 to 44 °C. It uses a temperature-controlled water bath heat source that is absolutely critical to the whole concept and a peristaltic pump. The uid is pumped at low volumes through a very high efciency heat exchanger. Temperatures are consistently monitored by an inline probe. The closed circuit delivers the uid to the bladder through a soft three-way silicone catheter. Alarm systems monitor for over pressure as well as temperatures outside either side of the therapeutic range. The major challenge faced in developing Combat was the research required to develop the heating plate for warming the Mitomycin. It took several years before multiple technical hurdles were overcome. Once this aspect of the system was functioning reliably the rest of the components proved easier to develop and integrate. The constant thermal gradient with no hot or cold spots optimises therapy for NIMBC Unithermia The Unithermia System uses a similar design but uses a different method of introducing the thermal gradient. The manufacturer calls it bladder wall thermotherapy (BWT). In this application the drug containing solution is heated to 46.5 °C from an outside source and circulated rapidly through the bladder reaching four uid changes per minute. The temperature of the uid coming into contact with the bladder is a very uniform 44 to 44.5 ° C. The high ow allows fresh drug to be continuously presented to the bladder wall. As with Combat the thermal gradients are safe and predictable. UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
RkJQdWJsaXNoZXIy NTIyOTQ=