Name of the Procedure:

Injection, valrubicin, intravesical, 200 mg (HCPCS Code J9357)

Summary

Intravesical valrubicin injection is a medical procedure where valrubicin, a type of chemotherapy drug, is administered directly into the bladder to treat bladder cancer. The drug is delivered through a catheter, allowing it to specifically target cancer cells in the bladder.

Purpose

This procedure is primarily used to treat bladder cancer, specifically carcinoma in situ (CIS) that has not responded to Bacillus Calmette-Guérin (BCG) therapy. The goal is to destroy cancer cells, reduce tumor size, and potentially avoid more invasive treatments like surgery.

Indications

• Carcinoma in situ (CIS) of the bladder.
• Failure of or intolerance to Bacillus Calmette-Guérin (BCG) therapy.
• Patients who are not candidates for more invasive surgical options.

Preparation

• Patients may be instructed to limit fluid intake a few hours before the procedure.
• Diagnostic tests such as cystoscopy or imaging studies may be required to assess the bladder.
• Pre-procedure medications might be adjusted, particularly anticoagulants.

Procedure Description

1. The patient will be asked to empty their bladder.
2. A catheter is inserted into the bladder through the urethra.
3. Valrubicin (200 mg) is injected through the catheter into the bladder.
4. The catheter is then removed.
5. The patient must retain the drug in the bladder for a specified time, usually around two hours, before emptying it through urination.

Duration

The entire procedure, including preparation and post-administration retention period, typically takes 2-3 hours.

Setting

The procedure is generally performed in an outpatient clinic or hospital setting.

Personnel

• Urologist or oncologist.
• Nurse or medical assistant for preparation and monitoring.

Risks and Complications

• Common: Bladder irritation, burning sensation during urination, urgency and frequency of urination.
• Rare: Urinary tract infection, hematuria (blood in the urine), bladder spasms, allergic reactions.

Benefits

• Directly targets bladder cancer cells, potentially reducing tumor size and preventing progression.
• Can offer an alternative to more invasive surgical treatments.
• Benefits can often be observed within a few weeks of treatment.

Recovery

• Post-procedure, patients are advised to drink plenty of fluids to flush out the bladder.
• Temporary restrictions on heavy lifting and strenuous activities.
• Follow-up appointments are necessary to monitor the response to treatment and manage any side effects.

Alternatives

• Continued BCG therapy.
• Radical cystectomy (surgical removal of the bladder).
• Other forms of intravesical chemotherapy or immunotherapy. Each alternative has its pros and cons, particularly regarding invasiveness, recovery time, and the extent of cancer control.

Patient Experience

• During the procedure, patients may feel mild discomfort during catheter insertion.
• Retaining the drug in the bladder can lead to a sensation of urgency or mild cramping.
• Post-procedure, increased urinary frequency and urgency are common but typically temporary.
• Pain management options, including over-the-counter pain relief, can help manage discomfort.