1649 the Benefit of Continuous Saline Bladder Irrigation After Transurethral Resection in Non-Muscular Invasive Bladder Cancer

Onishi, Takehisa; Sasaki, Takeshi; Hoshina, Akira

doi:10.1016/j.juro.2011.02.1759

Cited by 2 publications

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“…[ 20 ] In the urologic literature, Moskovitz et al first postulated in 1987 that intravesical irrigation with distilled water during and after TURBT would lead to fewer recurrences. [ 21 ] While several small studies have demonstrated conflicting results regarding the use of water irrigation compared with no perioperative treatment, no studies have compared CSBI to MMC until the aforementioned studies by Onishi et al [ 10 , 14 , 22 , 23 ] Our study is the first to compare a shorter, perioperative duration of CSBI to both MMC and no perioperative treatment, and to evaluate this strategy in a heterogeneous patient population with low, intermediate, and high risk disease.…”

Section: Discussionmentioning

confidence: 98%

“…Onishi et al performed a non-randomized study comparing 18–22 h of post-operative CSBI to a full year of induction and maintenance MMC in patients with European Organization for Research and Treatment of Cancer (EORTC) intermediate risk NMIBC and showed no difference in several outcomes, including recurrence-free rates, time to first recurrence, and frequency of recurrences. [ 10 ] In this manuscript, the authors alluded to a planned prospective study that was recently published. [ 14 ] In their follow-up study, 227 patients with primary EORTC low- to intermediate-risk (all LG) NMIBC were randomized 1:1 to receive CSBI for 18 h or a single dose of 30 mg of MMC in 30 mL of saline.…”

Section: Discussionmentioning

confidence: 99%

“…While CSBI for two hours postoperatively should not replace current guideline-recommended perioperative MMC, it does appear that longer duration of CSBI may increase its efficacy. [ 10 , 14 ] Research is needed to determine whether the duration can be reduced to limit the number of additional hospital stays and whether other, novel perioperative instillations may reduce recurrences and limit side effects.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] Alternatively, several groups have utilized sterile water and saline irrigation over 18–24 h as a strategy to lyse floating tumors cells and prevent the re-implantation of cells into the bladder wall. [ 9 , 10 ] In our current study, we sought to evaluate continuous bladder irrigation with isotonic (0.9% NaCl) normal saline (CBSI) for two hours following TURBT as a strategy to reduce recurrence or progression in patients with NMIBC.…”

Section: Introductionmentioning

confidence: 99%

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Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C

et al. 2018

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BackgroundIntravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare the rates of recurrence and/or progression in patients with NMIBC who were treated with either MMC or CSBI after TURBT.MethodsWe retrospectively reviewed records of patients with NMIBC at our institution in 2012–2015. Perioperative use of MMC (40 mg in 20 mL), CSBI (two hours), or neither were recorded. Primary outcome was time to recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed.Results205 patients met inclusion criteria. Forty-five (22.0%) patients received CSBI, 71 (34.6%) received MMC, and 89 (43.4%) received no perioperative therapy. On survival analysis, MMC was associated with improved DFS compared with CSBI (p = 0.001) and no treatment (p = 0.0009). On multivariable analysis, high risk disease was associated with increased risk of recurrence or progression (HR 2.77, 95% CI: 1.28–6.01), whereas adjuvant therapy (HR 0.35, 95% CI: 0.20–0.59) and MMC (HR 0.43, 95% CI: 0.25–0.75) were associated with decreased risk.ConclusionsPostoperative MMC was associated with improved DFS compared with CSBI and no treatment. The DFS benefit seen with CSBI in other studies may be limited to patients receiving prolonged irrigation. New intravesical agents being evaluated may consider saline as a control given our data demonstrating that short-term CSBI is not superior to TURBT alone.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C

et al. 2018

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“…They have concluded that CSBI after TURBT may be a feasible prophylactic and therapeutic option for patients with low- to intermediate-risk NMIBC ( 9 ). In a previous retrospective study, Onishi et al ( 10 ) have shown that CSBI after TURBT has a preventive effect on IVR of NMIBC.…”

Section: Introductionmentioning

confidence: 96%

Effect of continuous saline bladder irrigation with concomitant single instillation of chemotherapy after transurethral resection on intravesical recurrence in patients with non‑muscle‑invasive bladder cancer

et al. 2020

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A single immediate instillation of chemotherapy following transurethral resection of bladder tumor (TURBT) is effective in preventing intravesical recurrence (IVR) in patients with non-muscle-invasive urothelial bladder carcinoma (NMIBC). However, continuous saline bladder irrigation (CSBI) is also performed with a single instillation of chemotherapy (SIC), but its inhibitory effect on IVR remains unclear. In the present study, the effect of CSBI with concomitant SIC following TUR on IVR was evaluated in patients with NMIBC. A retrospective review of 253 patients who underwent TURBT and were clinically and histologically diagnosed with NMIBC at National Defense Medical College Hospital was performed. Doxorubicin (DXR) was administered to all patients. Methods of DXR administration included a single instillation of DXR (60 mg in 30-40 ml saline) in 34 patients (group A), continuous irrigation of the bladder with saline including DXR (80 mg in 1 liter saline) in 40 patients (group B) and overnight CSBI after a single instillation of DXR in 179 patients (group C). The difference in IVR-free survival rates was compared after adjusting for significant differences in several covariates between the groups by nearest-neighbor propensity score matching. Prior to propensity score matching, it was identified that time to IVR was significantly longer in group A than in groups B and C; however, it was observed that several factors significantly differed among the three groups. By using nearest neighbor matching, 18 pairs were matched between groups A and B and 33 pairs between the groups A and C. No significant difference was identified in any covariates between these two matched group pairsTime to IVR was significantly longer in the matched group A than in the matched groups B and C (P=0.0255 and P=0.0023, respectively). In conclusion, SIC alone could provide a higher IVR-free survival rate than CSBI with DXR or CSBI with SIC.

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1649 the Benefit of Continuous Saline Bladder Irrigation After Transurethral Resection in Non-Muscular Invasive Bladder Cancer

Cited by 2 publications

References 0 publications

Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C

Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C

Effect of continuous saline bladder irrigation with concomitant single instillation of chemotherapy after transurethral resection on intravesical recurrence in patients with non‑muscle‑invasive bladder cancer

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