Thank you for the updates and educating all of us. Also congrats on coming through BCG treatment with less pain this time.
Wikipedia says Lidocaine was discovered in 1945 and now it is included in WHO essential drug lists, also it is sold under different names. Esracain site also says it is Lidocaine Hydrochloride. So, it is likely Esracain is a trade name and Lidocaine is generic name.
In term of catheter, 8 is really small. They must have chosen it for you. The nurse manual of a Canadian hospital says #12 or #14 straight silicone catheter for females #12 or #14 Tieman catheter for males. But, European Association of Urology Nurse manual (EAUN15) for BCG instilment says to the use smallest possible catheter.
In regards to Chief nurse' comment on Estacaine (Lidocaine) on its impact to BCG efficacy, it may be true that no large scale studies are done for Lidocaine to compare the BCG efficacy with and without Lidocaine. The referenced study in the recommendation of Society of Immunotherapy and Cancer, which Dr. Ashish Kamat - a world well known urologist of MD Andersons was involved in preparing the recommendation, was done in 1996 in Germany. The study tested 5 different lubricants, including Lidocaine and identified that several components including Lidocaine hydrochloride were responsible for the inhibition of BCG viability. Fluid recovered from the bladder after lubricant assisted catherization also showed a inhibitory effect. I do not have access to the quantitative results.
Accordingly,
European Association of Urology Nurse manual 2015 edition says if possible choose a hydrophilic (self coated) catheter to reduce risk of discomfort, trauma and infection. In terms of lubricant, for non-hydrophilic catheters, 10-15ml of lubricant with lidocaine and chlorhexidine should be used. T
his does not significantly reduce the efficacy of BCG therapy.
Intravesical Administration of Therapeutic Medication for the Treatment of Bladder Cancer Jointly developed with the Society of Urologic Nurses and Associates (SUNA)
manual by AUA says in Administrative Precautions states
Lidocaine Jelly (2%) may be used. Some urologists prefer it not to be used with BCG, Mitomycin, Gemcitabine, or Docetaxel. Follow facilities guidelines regarding to use. ** it does not say why some urologists do not want to use lidocaine.
It seems that European Nurse manual and American Nurse manual are not fully consistent in terms of the use of lidocaine.
Also, it seems that the policy for using Lidocaine in BCG instilment is not fully consistent in what the urologic nurse manual says and Society of Immunotherapy and Cancer and Dr. Ashish Kamat is saying to bladder cancer patients. I think this reflects to patients commentating that some hospitals use Lidocaine always and some don't. It is noted that some patients who have lidocaine always are posing that BCG has worked well resulted in NED several years. This tells that Lidocaine will not make all BCG bacteria inviable.
I am curious to know what is MD Anderson nurse practice manual in administering BCG.
nurses.uroweb.org/wp-content/uploads/EAUN15-Guideline-Intravesical-instillation.pdf page 34
www.auanet.org/guidelines/guidelines/intravesical-administration-of-therapeutic-medication Sec XI. Administrative Precaution
best
