Efficacy of Postoperative Bladder Irrigation with Water for Injection in Reducing Recurrence Rates of Non Muscle Invasive Bladder Cancer

Nikolaos Grivas,Antonios Stratis,Spiridon Aspiotis,Vasileios Kafarakis,Konstantinos Hastazeris,Ioannis Tsimaris,Nikolaos Efthimios Stavropoulos

doi:10.7314/apjcp.2014.15.5.2263

Nikolaos Grivas, Antonios Stratis + Show 5 more

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https://doi.org/10.7314/apjcp.2014.15.5.2263

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Journal: Asian Pacific Journal of Cancer Prevention	Publication Date: Mar 1, 2014
Citations: 26	License type: cc-by

Abstract

The aim of the study was to investigate the results of bladder irrigation with Water for Injection (WFI) after transurethral resection of bladder tumours for comparison with those for adjuvant use of BCG. A total of 239 patients (158 with single tumours, group A, and 81 with multiple tumours, group B) received continuous intravesical postoperative irrigation with WFI. Some 128 patients received intravesical irrigation with WFI, followed by weekly instillations of BCG (group C). Recurrence-free rate (RFR) and recurrence-free intervals (RFI) were recorded. RFR for those patients who received only intravesical irrigation with WFI (groups A and B) was 75.8%, 66.2% and 63.2% at the 1st, 2nd and 3rd year of follow up, respectively. Corresponding rates for group C were 61.7%, 55.4% and 49%. Median RFI in group B were 18, 11, 15, 15 and 12 months for Ta, T1, grade 1, grade 2 and grade 3 tumours, respectively. In group C corresponding intervals were 20, 33, 8, 20 and 42 months. BCG improved RFR only in T1 (p=0.014) and grade 3 tumours (p=0.007). In conclusion, postoperative bladder irrigation with WFI could increase RFR during the first and second year of follow up.

Highlights

Transurethral resection (TUR) remains the gold standard for the treatment of non muscle invasive bladder tumors (NMIBC)
Asian Pacific Journal of Cancer Prevention, Vol 15, 2014 2263. In this retrospective study we investigated the efficacy of continuous bladder irrigation with water for injection immediately after TUR both in single and multiple bladder tumours of all stages and grades, while patients with multiple tumours were compared to those who had multiple tumours and received intravesical instillations of bacillus Calmette-Guerin (BCG)
Patients in group A were compared with 128 patients with multiple tumors treated with continuous bladder irrigation with water for injection followed by 6-8 weekly intravesical instillations of BCG, beginning two weeks after transurethral resection

Summary

Introduction

Transurethral resection (TUR) remains the gold standard for the treatment of non muscle invasive bladder tumors (NMIBC). State-of-the-art TUR by itself can eradicate Ta, T1 tumours completely, these tumours commonly recur and can progress to muscle invasive (MIBC) (Witjes, 2009). There are controversial results from studies evaluating the adjuvant role of a single, postoperative intravesical instillation of chemotherapy regimens such as epirubicin, mitomycin C and gemcitabin within 24 hours after transurethral resection (Tolley et al, 1988; Oosterlinck et al, 1993; Hall, 1997; Brocks et al, 2005). Guidelines of the European Association of Urology for the treatment of NMIBC recommend that all patients receive one immediate instillation of chemotherapy after TUR. In patients at low risk of recurrence and progression, no further treatment is recommended prior to a subsequent recurrence. In patients with high-grade tumors or carcinoma in situ (CIS), bacillus Calmette-Guerin (BCG) immunotherapy is recommended (Babjuk et al, 2013)

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