Böhle A, Rüsch-Gerdes S, Ulmer A J, Braasch H, Jocham D
Department of Urology, Medical University of Lübeck, Germany.
J Urol. 1996 Jun;155(6):1892-6.
The viability of bacillus Calmette-Guerin (BCG) is crucial for induction of a local immune response and for effective therapy of recurrent superficial bladder carcinoma. During intravesical instillation of BCG lubricants are administered to assist catheterization, which contain bacteriostatic components that may interfere with the viability of mycobacteria. To verify this assumption, 5 commercially available lubricants were analyzed with regard to inhibition of viable BCG growth.
Five different lubricants and their components were co-incubated with Connaught strain BCG and the resultant growth of BCG was assessed. To prove the significant passage of lubricants into the bladder, fluid was recovered from the bladder after catheterization, analyzed with regard to the bacteriostatic effect and compared to normal urine of different acidity.
Significant impairment of BCG viability, dependent on dosage and time of co-incubation, was noted with all lubricants analyzed. Several components, namely lidocaine hydrochloride, glyceryl stearate, propyl-4-hydroxy-benzoate and chlorhexidine digluconate, were identified as responsible for this inhibition. Fluid recovered from the bladder after lubricant assisted catheterization also showed an inhibitory effect, indicating significant mixture of the instillate with lubricants.
Generous use of lubricants to assist catheterization during intravesical BCG therapy will result in a clinically significant decrease in the number of intravesically instilled viable mycobacteria. For this reason, during intravesical immunotherapy with BCG only small amounts of lubricants should be used for urethral catheterization, and use of catheters not requiring lubricants should be considered.
卡介苗（BCG）的活性对于诱导局部免疫反应以及有效治疗复发性浅表性膀胱癌至关重要。在膀胱内灌注BCG期间，会使用润滑剂辅助插管，而这些润滑剂含有可能干扰分枝杆菌活性的抑菌成分。为证实这一假设，对5种市售润滑剂抑制BCG活菌生长的情况进行了分析。
将5种不同的润滑剂及其成分与康诺特菌株BCG共同孵育，并评估BCG的生长情况。为证明润滑剂能大量进入膀胱，插管后从膀胱回收液体，分析其抑菌效果，并与不同酸度的正常尿液进行比较。
在所分析的所有润滑剂中，均发现BCG活性有显著损害，且损害程度取决于共同孵育的剂量和时间。确定了几种成分，即盐酸利多卡因、硬脂酸甘油酯、对羟基苯甲酸丙酯和葡萄糖酸洗必泰，是造成这种抑制作用的原因。润滑剂辅助插管后从膀胱回收的液体也显示出抑制作用，表明灌注液与润滑剂有大量混合。
在膀胱内BCG治疗期间大量使用润滑剂辅助插管，将导致膀胱内灌注的活菌数在临床上显著减少。因此，在膀胱内BCG免疫治疗期间，尿道插管应仅使用少量润滑剂，并应考虑使用无需润滑剂的导管。
