In new guidance, NICE recommends that electrically-stimulated intravesical chemotherapy should not be used for the routine treatment of non-muscle-invasive bladder cancer.
NICE has concluded that current evidence shows there are no major safety concerns with the treatment but says evidence on efficacy is limited in quantity and quality. “Therefore, this procedure should only be used in the context of research,” it advises, saying further research should include randomised controlled trials compared with standard care, which should report details of patient selection.
Electrically stimulated intravesical chemotherapy (also known as electromotive drug administration) involves the use of a device to create an electric field across the bladder wall, with the aim of stimulating directional ionic and solute movement of the intravesical fluid. This increases absorption of the drug (usually mitomycin C) into the bladder lining.
The procedure is usually done using local anaesthesia, with the patient in a supine position. Electrode pads are placed on the skin of the lower abdomen and a catheter with an intravesical electrode is inserted into the bladder through the urethra.
Treatment sessions last about 30 minutes and are repeated, often weekly, for four to eight weeks or longer for adjuvant treatment. After the procedure, the bladder is drained and the catheter is removed.