Do bacteriostatic urethral lubricants affect the clinical efficacy of intravesical bacillus Calmette-Guerin therapy?

Objectives. To investigate the effect of a bacteriostatic urethral lubrican t on the clinical efficacy of intravesical bacillus Calmette-Guerin (BCG) t herapy. Methods, Between July 1987 and August 1999, 389 patients with superficial u rothelial carcinoma of the bladder (pTa [multilocular, size greater than 2 cm, recurrent tumor], pT1, pTis) were treated adjuvantly with BCG in a 6-we ek intravesical cycle after complete transurethra( tumor resection of the b ladder, Within the framework of a prospective study on recurrence and progr ession of superficial urothelial carcinoma of the bladder after transurethr al resection and BCG therapy, we retrospectively studied the clinical value of the observation that the use of bacteriostatic urethral lubricants redu ces the viability and thus the efficacy of BCG. If a lubricant induces a cl inically relevant reduction in the viability of BCG, instillation without l ubricant should lead to a lower rate of recurrence and possibly a lower rat e of progression, Lubricant [11 mt) was used during catheterization in ever y male patient in our population (group 1, n = 317, 81.5%); no lubricant wa s used in the women sewing as the control group (group 2, n = 72, 18.5%). T he two groups were similar with respect to age, distribution of tumor stage and grade, multifocality, and frequency of previous bladder carcinoma (Lev ene test, P = 0.008). The median follow-up was 54 months (range 4 to 143). Results, Of the 389 patients, 90 (23.1%) developed recurrence during the fo llow-up period: 73 (23%) in group 1 and 17 (25.6%) in group 2 (P value not significant). Progression occurred in 14 patients in group 1 (4.4%) and in 8 patients in group 2 (11%) (P = 0.043). In groups 1 and 2, 19.2% and 47.1% , respectively, of the recurrences were progressive (P = 0.026). Conclusions, The use of bacteriostatic lubricants in the usual dose before BCG instillation had no detectable adverse effect on the clinical efficacy of intravesical BCC immunotherapy. To avoid traumatic catheterization with possible systemic BCC administration, we therefore recommend, especially in men, the additional use of a sufficient quantity of urethral lubricant. UR OLOGY 57: 900-905, 2001. (C) 2001, Elsevier Science Inc.