MP72-17 OSMOTIC CYTOLYTIC EFFECTS OF WATER ON CELL COUNTS – IMPLICATIONS FOR CLINICAL USE OF WATER IRRIGATION TO REDUCE NON-MUSCLE INVASIVE BLADDER CANCER RECURRENCE

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive III (MP72)1 Apr 2020MP72-17 OSMOTIC CYTOLYTIC EFFECTS OF WATER ON CELL COUNTS – IMPLICATIONS FOR CLINICAL USE OF WATER IRRIGATION TO REDUCE NON-MUSCLE INVASIVE BLADDER CANCER RECURRENCE Ruchira Nandurkar*, Mo Li, Pavel Sluka, Hady Wardan, Ian Davis, and Shomik Sengupta Ruchira Nandurkar*Ruchira Nandurkar* More articles by this author , Mo LiMo Li More articles by this author , Pavel SlukaPavel Sluka More articles by this author , Hady WardanHady Wardan More articles by this author , Ian DavisIan Davis More articles by this author , and Shomik SenguptaShomik Sengupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000952.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrence of Non-Muscle Invasive Bladder Cancer (NMIBC) following initial transurethral resection of the bladder tumour (TURBT) is observed in 40-80% of patients. One cause of this is intraoperative tumour exfoliation during resection, leading to tumour cell re-implantation and local recurrence. Immediate post-TURBT instillation of intravesical chemotherapy is effective at reducing recurrence, but remains underutilised. A potentially less expensive or toxic alternative may be to mechanically wash out free-floating tumour cells via irrigation. Irrigating with sterile water may be even more effective compared to iso-osmotic irrigants (such as saline) by virtue of osmotic cytolysis in addition to rinsing out exfoliated cells, although this has not been well characterised. The aim of this study was to ascertain the impact of water on cell viability on both in vitro and ex vivo samples. METHODS: Two bladder cancer cell lines (HT1197 and HT1376) were cultured, and exposed to water, 0.9% saline or 1.5% glycine for up to 5 hours. Viable and non-viable cells (determined using trypan blue staining) were manually counted on a haemocytometer. Similarly, hourly 200mL washout samples from 19 patients receiving 3 hours of either saline or water irrigation following TURBT were collected for cell counting. Trends for cell numbers over time were assessed using Friedman’s test, with statistical significance at p<0.05. Ethics approval was granted for this in vivo trial. RESULTS: In vitro, exposure to water led to a rapid decline in viable cells to zero within the first 20 minutes, whereas viable cell numbers slowly declined but remained detectable up to 5 hours when exposed to saline or glycine. 11 patients received water irrigation in vivo, and their median viable cell count reduced from 20 x 103 at time 0 to zero cells within one hour and beyond (p = 0.01). In contrast, saline-irrigated patients had a median viable cell count of 50 x 103 initially, which decreased to 8 x 103 after one hour and then remained stable, never decreasing to zero cells (p = 0.98). Immunohistochemistry on ex vivo samples showed significant numbers of bladder epithelial cells in saline irrigated patients in contrast to water irrigated patients. CONCLUSIONS: Our results demonstrate that water has an osmolytic effect upon bladder cancer cells in vitro and reduces the number of cells detected in catheter washout effluent in vivo. This suggests that a short period of irrigation with water post-TURBT may be a viable intervention in reducing NMIBC recurrence. Source of Funding: Trial sponsored by ANZUP Below-The-Belt Grant © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1081-e1081 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruchira Nandurkar* More articles by this author Mo Li More articles by this author Pavel Sluka More articles by this author Hady Wardan More articles by this author Ian Davis More articles by this author Shomik Sengupta More articles by this author Expand All Advertisement PDF downloadLoading ...