Continuous Bladder Irrigation after Transurethral Resection of Non-Muscle Invasive Bladder Cancer for Prevention of Tumour Recurrence – A Systematic Review

Abstract

Non-muscle invasive bladder cancer (NMIBC) has a high recurrence rate despite transurethral resection of bladder tumour (TURBT) for clearance of macroscopic disease, partly as a result of seeding from exfoliated malignant cells. The immediate instillation of intravesical chemotherapy (IC) can reduce recurrence and is guideline-recommended but has low usage. It is postulated that continuous bladder irrigation (CBI) immediately post TURBT can itself prevent re-implantation and reduce recurrence, which may provide a simple, cheap and practical alternative to IC. We undertook a systematic review of the literature to assess the effect of CBI on NMIBC recurrence. Following PRISMA guidelines, relevant publications were identified from an online search of the literature using databases including Ovid Medline and EMBASE between 1980 to 2018. All published prospective randomized controlled trials (RCTs) which compared CBI post-TURBT to a control group were included. The primary endpoint of the study was recurrence Our search yielded 514 studies of which six met our inclusion criteria. Two studies (935 participants) comparing CBI to no CBI showed a reduction in recurrence at 2 years. Four publications from 3 trials (331 participants) compared CBI to IC, showing comparable recurrence rates at 1 year (OR 1.29, 95% confidence interval 0.78 to 2.13) but a lower risk of adverse events (6-34% vs 27-48%). CBI post TURBT appears to yield one-year recurrence rates of NMIBC comparable to immediate IC. However, existing studies are small and of heterogenous design, precluding definitive conclusions. Further trials are required to determine if CBI can be implemented routinely to reduce NMIBC recurrence, as well as the optimal irrigant, volume and duration.