Electrically stimulated chemotherapy for non muscle invasive bladder cancer

For this treatment, you have chemotherapy into your bladder. At the same time, the doctor passes a small electrical current through your bladder.

The treatment is also called:

• electrically stimulated intravesical chemotherapy
• electromotive drug administration (EDMA)
• iontophoresis (pronounced i-on-toe-for-ee-sis)

The electrical current appears to make the chemotherapy work better. It may make it easier for the bladder lining to absorb more of the chemotherapy.

When do you have electrically stimulated chemotherapy?

You might have this treatment for high risk non muscle invasive bladder cancer that:

• remains or comes back after you had chemotherapy or BCG into the bladder

Or in some hospitals, you might have it as your first treatment into your bladder.

You might have it either before or after surgery (TURBT).

You usually only have it as a part of clinical trials. There is not yet enough evidence for how well it works to make it more widely available.

You have this treatment once a week for 6 weeks. Each treatment lasts for about 30 minutes.

What happens

Where you have it

You usually have treatment at the cancer day clinic.

Before you start electrically stimulated chemotherapy

This treatment is part of a clinical trial only. So, you’ll usually meet a research nurse who will explain what will happen during the clinical trial and what to expect.

You have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

On the day the nurse will check your urine to see if you have any infection or sign of blood.

Before each treatment you need to stop drinking fluids. This stops the urine from diluting the drug in your bladder and will help you hold the urine more easily. Your hospital will tell you when to stop drinking.

How you have it

On the day you’ll have to undress from the waist down. The doctor will ask you to lay down on your back on the couch. Your bladder must be empty before you have this treatment. You have an ultrasound scan to check this.

You have the treatment through a thin tube (catheter). The catheter goes into your bladder through the urethra. The urethra is the tube that carries wee (urine) from the bladder out of the body.

The doctor or nurse puts the catheter into your bladder. The catheter contains a small electrode.  The doctor sticks two patches onto the skin on the lower part of your tummy (abdomen). These patches also contain electrodes.

Your doctor attaches the wires from the electrodes to a small generator. They put the chemotherapy drug into your bladder through the catheter. Then they switch the generator on.

A small electrical current passes through the electrodes. You may have a small tingling or stinging feeling where the patches are. This should not be painful. The electrical current draws the drug into the cells of the bladder lining.

After the treatment, the doctor or nurse drains the chemotherapy out of your bladder and takes out the catheter. They remove the patches.

When you go home

Bladder cancer and its treatment can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

There may be a small amount of chemotherapy left in your bladder after treatment. So you should:

• drink lots of fluid (2-3 litres) after this treatment to helps clear your system of chemotherapy
• be careful when you pass urine so that you don't get it on your skin - men should sit down to pass urine, to reduce the chance of splashing

Possible side effects

You get fewer side effects having chemotherapy into your bladder than you would having chemotherapy into a vein. This is because the drug tends to stay in your bladder. So very little of it gets into your bloodstream.

Some of the side effects might include:

Irritation of the bladder 

Chemotherapy can irritate your bladder. You may feel as if you have a bad urine infection (cystitis). This can make you :

• pass urine very often
• pass urine with urgency 
• feel uncomfortable
• feel some pain

Blood in your urine

You may have a small amount of bleeding. Contact the hospital immediately if:

• the bleeding is getting worse
• there are blood clots in your urine
• you have severe pain when passing urine
• you can't pass urine and have severe pain

Skin rash and itching

You may get a rash on your hands or feet for a short time after having this treatment. Some skin rashes may get red, sore and swollen. Some people get severe itching. Contact your doctor if you get any of these symptoms.

Infection

Some chemotherapies can increase your risk of getting an infection. You're also at increased risk of infection from having a catheter put in. If you generally feel unwell, severe pain, bad smelling urine or discharge or have a temperature contact your doctor.   

Allergic reaction

There is a risk of having an allergic reaction to the chemotherapy. But this is rare. If it does happen the nurse gives you medicines to control the reaction. Tell the doctor or nurse if you feel unwell at any time.

Burns to the skin

There is a very small risk that the patches on your skin may cause a burn. The doctor or nurse make sure they are put on properly to prevent any air getting between them.