6 patient's male partner should also use a condom. • Women of childbearing age should all be on some form of contraception for the duration of the treatment. • Ladies breast feeding will need to stop during the period of treatment. • Patients should all receive counselling prior to the procedure in terms of providing information about the drugs, what to expect during catheterisation and what can be experienced during the hyperthermic treatment. • Patients should be provided with a list of the possible side effects. This form should contain guidance on when it becomes imperative to contact the prescribing urologist. • Patients should all uid restrict for eight hours so that during the procedure they are not producing large volumes of urine which would dilute the chemotherapeutic solution. • Patients on routine diuretic therapy are asked to avoid these medications for six hours prior to the procedure and then to take the drug after the procedure. • Afterwards patients are asked to drink large volumes of water to wash the drug out of their system. In patients with heart failure this advice would need to be somewhat tempered. The exception to this last rule is mitomycin C. • Men should sit and void for the rst day after treatment to avoid splashes. • Caffeine, carbonated drinks, acidic drinks, alcohol and spicey foods should be avoided for the rst forty-eight hours after treatment because of these products irritant effect on the bladder. • Do not administer these drugs when a patient has an active urinary infection. As I stated at the beginning of the article, this is not an exciting topic but there is ample proof that these devices are safe, and the side effect prole of the various drugs used with the devices is more than acceptable. When compared with standard BCG therapy there is a lot of data now that shows the drugs are better tolerated. Urologists need to become au fait with handling toxicities. I leave with a quote from one of my heroes, Albert Einstein. “Concern for man himself and his safety must always form the chief interest of all technical endeavour”. In the next article I will discuss the question of whether the treatment actually works to prevent patients from needing to take the step of last resort which is the cystectomy. Bibliography Safety and efcacy of intravesical chemotherapy and hyperthermia in the bladder: results of a porcine study: Tan, WP; Chang, A; Brousell, SC; Grimberg, DC; Fantony, JJ; Longo, TA; Etienne, W; Spasojevic, I; Maccarini, P; Inman, BA; Int J Hyperthermia; Vol 37/1, 854 – 860, 2020 Salvage Hyperthermic Gemcitabine and Docetaxel Combination Chemotherapy After BCG Failure in Non-Muscle Invasive Bladder Cancer Patients: Rao, Mounica Y. Kang, Paul Tarajkowski, Jamaka C. Mobley, Debra L. Lamm, Donald L. Bladder Cancer, vol. 6, no. 1, pp. 25-32, 2020 Comparison of Side Effects and Tolerability Between Intravesical Bacillus Calmette-Guerin, Reduced-Dose BCG and Gemcitabine for Non-Muscle Invasive Bladder Cancer: Joshua M. Kuperus, Ross D. Busman, Susan K. Kuipers, Helen T. Broekhuizen, Sabrina L. Noyes, Christopher M. Brede, Conrad M. Tobert, and Brian R. Lane; UROLOGY 00: 1-8, 2021. Heated Intravesical Chemotherapy: Biology and Clinical Utility. Wei Phin Tan, MD, Thomas Longo, MD, and Brant A. Inman, MD, MS; Urol Clin North Am. 2020 Feb; 47(1): 55–72. COMPLICATIONS OF INTRAVESICAL THERAPY: Basir Tareen MD, Samir S. Taneja MD, in Complications of Urologic Surgery (Fourth Edition), 2010 Intravesical radiofrequency induced hyperthermia enhances mitomycin C accumulation in tumour tissue: F. Johannes P. van Valenberg, Antoine G. van der Heijden, Rianne J. M. Lammers, Johannes Falke, Tom J. H. Arends, Egbert Oosterwijk & J. Alfred Witjes; International Journal of Hyperthermia; 01 Dec 2017. Intravesical device-assisted therapies for non-muscle invasive bladder cancer: Wei Shen Tan1,2 and John D. Kelly; Nat Rev Urol; 2018 Nov; 15 (11):667-685. Long-Term Experience with Radiofrequency-Induced Hyperthermia Combined with Intravesical Chemotherapy for Non-Muscle Invasive Bladder Cancer : Iris S. G. Brummelhuis, Yvonne Wimper, Hilde G. J. M. Witjes-van Os, Tom J. H. Arends, Antoine G. van der Heijden, and J. Alfred Witjes ; Cancers (Basel). 2021 Feb; 13(3): 377. Phase I Trial of Intravesical Docetaxel in the Management of Supercial Bladder Cancer Refractory to Standard Intravesical Therapy: James M. McKiernan, Puneet Masson, Alana M. Murphy, Manlio Goetzl, Carl A. Olsson, Daniel P. Petrylak, Manisha Desai, and Mitchell C. Benson; J Clin Oncol 24:30753080. Medical technologies consultation document – GID-MT553 Synergo for non-muscle-invasive bladder cancer Issue date: June 2021 © NICE 2021 The clinical efcacy and safety of equipment-assisted intravesical instillation of mitomycin C after transurethral resection of bladder tumour in patients with nonmuscular invasive bladder cancer: A meta-analysis: Weijian Zhou, Jianping Liu, Dongdong Mao, Changying Hu, Dianjun Gao; PLoS One. 2022; 17(10) The efcacy and safety of intravesical gemcitabine vs Bacille Calmette-Guérin for adjuvant treatment of non-muscle invasive bladder cancer: a meta-analysis: Ziqi Ye,1,* Jie Chen,2,* Yun Hong,1 Wenxiu Xin,3 Si Yang,1 and Yuefeng Rao; Onco Targets Ther. 2018; 11: 4641–4649. Thermal Intravesical Chemotherapy Reduce Recurrence Rate for Non-muscle Invasive Bladder Cancer Patients: A Meta-Analysis: Kang Liu,† Jun Zhu,† Yu-Xuan Song, Xiao Wang, Ke-Chong Zhou, Yi Lu, and Xiao-Qiang Liu; Front Oncol. 2020; 10: 29 Value of an Immediate Intravesical Instillation of Mitomycin C in Patients with Non–muscle-invasive Bladder Cancer: A Prospective Multicentre Randomised Study in 2243 patients: Judith Bosschieter a, Jakko A. Nieuwenhuijzen a, Tessa van Ginkel a, Andre´ N. Vis a, Birgit Witte b, Don Newling a, Goedele M.A. Beckers a, R. Jeroen A. van Moorselaar ; Eur Urol; . 2018 Feb;73(2):226-232. Read Chapter 1 and Chapter 2 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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