THE EFFECT OF LUBRICANTS ON VIABILITY OF BACILLUS-CALMETTE-GUERIN FORINTRAVESICAL IMMUNOTHERAPY AGAINST BLADDER-CARCINOMA

Purpose: The viability of bacillus Calmette-Guerin (BCG) is crucial fo r induction of a local immune response and for effective therapy of re current superficial bladder carcinoma. During intravesical instillatio n of BCG lubricants are administered to assist catheterization, which contain bacteriostatic components that may interfere with the viabilit y of mycobacteria. To verify this assumption, 5 commercially available lubricants were analyzed with regard to inhibition of viable BCG grow th. Materials and Methods: Five different lubricants and their compone nts were co-incubated with Connaught strain BCG and the resultant grow th of BCG was assessed. To prove the significant passage of lubricants into the bladder, fluid was recovered from the bladder after catheter ization, analyzed with regard to the bacteriostatic effect and compare d to normal urine of different acidity. Results: Significant impairmen t of BCG viability, dependent on dosage and time of coincubation, was noted with all lubricants analyzed. Several components, namely lidocai ne hydrochloride, glyceryl stearate, propyl-4-hydroxy-benzoate and chl orhexidine digluconate, were identified as responsible for this inhibi tion. Fluid recovered from the bladder after lubricant assisted cathet erization also showed an inhibitory effect, indicating significant mix ture of the instillate with lubricants. Conclusions: Generous use of l ubricants-to assist catheterization during intravesical BCG therapy wi ll result in a clinically significant decrease in the number of intrav esically instilled viable mycobacteria. For this reason, during intrav esical immunotherapy with BCG only small amounts of lubricants should be used for urethral catheterization, and use of catheters not requiri ng lubricants should be considered.