Rigi10™ Malleable Penile Prosthesis
Also Known As
Bladder wash, bladder bath, intravesical therapy, intravesical treatment, intravesical instillation, vesical instillation
Definition
Bladder instillation is a therapeutic procedure that involves introducing medication directly into the bladder through a catheter, allowing the solution to remain in place for a specified period before being drained.1 This treatment delivers medication directly to the bladder lining, bypassing systemic circulation and targeting the affected tissue.2 The procedure is primarily used to treat various bladder conditions by repairing damaged urothelial barriers, reducing inflammation, and alleviating symptoms such as pain, urgency, and frequency.3
A healthy bladder has a natural protective barrier called the glycosaminoglycan (GAG) layer that shields the bladder lining from irritants in urine.4 When this layer is damaged, urine may come into direct contact with the bladder lining, causing inflammation and symptoms. Bladder instillation works by reducing inflammation and discomfort within the bladder, helping to ease these symptoms and potentially restore the protective lining.5
Clinical Context
Bladder instillation is clinically indicated for several conditions, including interstitial cystitis/bladder pain syndrome (IC/BPS), recurrent urinary tract infections, sediment accumulation in urine, blocked catheters, and limited bladder capacity causing frequent urination.1,3
The American Urological Association’s clinical guidelines recommend bladder instillations as a treatment option when more conservative approaches such as diet modification, stress management, and over-the-counter products are insufficient to manage symptoms.4,5
Patient selection criteria typically include those with:
- Chronic bladder inflammation conditions like interstitial cystitis
- Painful bladder or cystitis-type symptoms
- Urinary frequency and urgency that has not responded to oral medications
- Recurring urinary tract infections
- Damaged bladder lining (GAG layer)3,4
The procedure involves:
- Pre-measuring the medication solution
- Inserting a catheter through the urethra into the bladder
- Instilling the solution into the bladder
- Allowing the solution to remain in place for approximately 15 minutes (time varies by medication)
- Draining the solution through the catheter1,3
Treatment protocols typically involve weekly instillations for 6-8 weeks, followed by maintenance treatments every few weeks or months based on symptom response.3,5 Multiple types of solutions may be used, including:
- Dimethyl sulfoxide (DMSO, brand name RIMSO-50): The only FDA-approved bladder instillation specifically for IC/BPS, approved in 1978. It works by reducing bladder irritation, relaxing bladder and pelvic muscles, relieving pain by depleting substance P levels, and increasing bladder capacity by preventing scar tissue formation.4
- Heparin: Helps repair damage to the mucus lining of the bladder and may reduce IC relapse rates.3
- Sodium hyaluronate (Hyacyst): Contains sodium hyaluronate, which helps restore the GAG layer.4
- Rescue mix/cocktails: Combinations of medications such as heparin, lignocaine (lidocaine), and sodium bicarbonate.2,4
Expected outcomes include symptom improvement within 3-4 weeks after treatment begins, with potential long-term management of chronic conditions through maintenance treatments.3