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Printed at: 09:31:00 / 28-02-2021

Intravesical Epirubicin chemotherapy: Procedure specific information

Please note, this page is printable by selecting the normal print options on your computer.

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence-based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your GP or other healthcare professionals. Alternative treatments are outlined below and can be discussed in more detail with your Urologist or Specialist Nurse.

What does the procedure involve?
Instillations of Epirubicin into the bladder for aggressive, multiple or recurrent superficial cancer of the bladder.

What are the alternatives to this procedure?
Repeated cystoscopy, radiotherapy, surgical removal of the bladder with urinary diversion or bladder reconstruction, systemic chemotherapy.

What should I expect before the procedure?
Your Consultant Urologist has referred you for treatment of your superficial bladder cancer. Superficial bladder cancer affects a few layers of cells on the inner surface of the bladder only but has the ability to progress to more aggressive disease If not treated effectively. The aim of the treatment, therefore, is to stop or slow down regrowth by instilling a drug into the bladder; this is called intravesical chemotherapy. You will be asked to come to the hospital once a week for 6 weeks. You should limit your fluid input for 6 hours before each treatment. Your first treatment will take up to 90 minutes. On arrival in the clinic, you will be asked to pass urine which will be tested to ensure that you do not have an infection in the urine. If you do, your treatment will need to be postponed for one week while you are treated with antibiotics.

Please be sure to inform your Urologist/nurse in advance of your surgery if you have any of the following:
• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for Warfarin, Aspirin or
Clopidogrel (Plavix®)
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)

What happens during the procedure?
A fine plastic tube (called a catheter) will be passed into the bladder and the medication (approximately half a cup of fluid) will be given through it. The catheter will then be removed. You will be asked not to pass urine for an hour to allow the medication to treat the bladder lining. On your first visit, you will be asked to stay in the clinic for the duration of the treatment and you will be asked to pass urine before you go home. For the remaining treatments, If you live within 20 minutes of the hospital and have your own transport, you may be allowed to go home with the medication in your bladder and pass urine after two hours.

What happens immediately after the procedure?
Once the treatment has been completed, you will be able to go home. You will need to ensure that you have a supply of household bleach at home, since you must pour a cupful of this into the toilet, leaving it for 15 minutes before flushing. You should continue doing this every time you pass urine for the next 24 hours. There is no risk of contamination. You should drink plenty of fluids (2-3 litres) for the few days after the treatment.

Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a
urological procedure. Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction: –

Common (greater than 1 in 10)
• Some bladder discomfort after treatment
• Flu-like symptoms which can persist for 2-3 days
• Discoloured urine
• Blood in the urine
• Debris in the urine

Occasional (between 1 in 10 and 1 in 50)
• Skin rash
• Failure to complete the course of treatment due to bladder discomfort
• Urinary tract infection
• Stricture of the urethra (water pipe) following repeated use of a catheter

Rare (less than 1 in 50)
• Severe pain on instillation, persisting afterwards
• Allergic reaction to the instilled chemicals, requiring discontinuation of the treatment
• Stricture of the urethra (water pipe) following use of a catheter

What should I expect when I get home?
Milton Keynes University Hospital NHS Foundation Trusts checks and reviews links and content to external websites at the time patient information goes to print. Please note, links and content on external websites may be changed, updated, or removed. If you think you have a urine infection (i.e. pain on passing urine, frequency or foul-smelling urine), it is important to contact your GP and get treatment with antibiotics.

What else should I look out for?
Because this treatment is put directly into the bladder and not into the blood stream, you will not experience the side-effects often associated with other cancer drug treatments.

Are there any other important points?
You should wash your hands and genitals after you have passed urine and it is advisable to bring a wash bag with you to Hospital when you come for the treatment. You are advised not to have sexual intercourse for at least 24 hours after the treatment as this can cause some discomfort. If you are a smoker, we will encourage you to stop since smoking seems to encourage recurrence of bladder cancer.

Who can I contact for more help or information?
Uro-Oncology Nurses on 01908 996901 or via hospital switchboard on bleep 1400.  Your consultant’s secretaries via hospital switchboard.

Additional questions