Complications associated with single-dose, perioperative mitomycin-C for patients undergoing bladder tumor resection

Abstract

OBJECTIVES To better understand the risk of short-term complications associated with perioperative intravesical mitomycin-C (MMC) therapy for patients undergoing endoscopic management of non-muscle invasive bladder cancer (NMIBC). METHODS AND MATERIALS Using an institutional database of patients with bladder cancer, we performed a retrospective case-control study of patients receiving perioperative MMC after tumor resection (2008–2012). MMC cases were matched by clinical stage to controls receiving endoscopic resection alone. Demographic information, clinicopathologic details and outcomes were compared between groups. Outcomes of interest included overall, genitourinary (GU) and major complications. Chi-square tests and multivariable logistic regression were used to evaluate associations between patient characteristics, clinical factors, exposure to MMC and outcomes of interest. RESULTS One-hundred sixteen patients treated with MMC were matched to 116 controls. Patients receiving MMC were younger (p=0.04) and more likely to have invasive disease (i.e., T1 or greater) (23% vs. 15%, p=0.02). Complications were more frequent among patients who were treated with MMC (34.5% vs. 19.8%, OR 2.89, 95% CI 1.43–5.81). The most common complication among MMC patients that required medical management was dysuria (17%). Major complications were more common among MMC patients (5.2% vs. 0.9%), but this difference did not reach statistical significance (p=0.11). CONCLUSIONS Use of MMC is associated with a greater odds of complications compared to controls. Patients should be counseled regarding both the benefits and potential risks of perioperative intravesical MMC. Continued research is required to understand the safety implications associated with the use of perioperative, intravesical MMC.

Update on the guideline of guidelines: non‐muscle‐invasive bladder cancer

“…Along with TUR, intravesical therapy is the mainstay of therapy/prevention for NMIBC. Single‐dose postoperative chemotherapy has been shown to reduce the risk of recurrence , however, 67% of urologists in a national US sample never administer immediate postoperative therapy owing to lack of chemotherapy availability, expense, tumour depth/perforation uncertainty, or fear of toxic side effects . Recent results published by the SWOG group showed that single‐dose postoperative intravesical gemcitabine reduces recurrence by 20% in histologically confirmed low‐grade NMIBC at a median follow‐up of 4 years in a randomized prospective sample .…”

Ibuprofen Decreases Spontaneous Activity and Enhances Nerve-Evoked Contractions to Minimize Mitomycin C-Induced Bladder Dysfunction

“…Mitomycin C is the most common cytotoxic drug used to treat bladder cancer and has been shown to reduce the risk of recurrence (Bosschieter et al, 2018). Although it is an effective intravesical treatment, mitomycin C (MMC) is known to cause urological side effects in 34.5%-41% of patients who undergo treatment, the most common being increased urinary frequency and urgency, and painful urination (Thrasher and Crawford, 1992;Filson et al, 2014). Other side effects include pelvic pain and hematuria.…”

<p>Bladder Neck Resection Combined with Ten Point Intralesional Mitomycin C Injection in Management of Refractory Bladder Neck Contracture in Post TURP Status: A Single-Center, 2-Year Experience</p>

“…The most regular complication following even a single dosage of MMC is aseptic cystitis, present as urinary urgency, frequency and dysuria. 11 Vanni et al, 14 with their study showed 72% success in 18 patients managed with deep cold-knife incision subsequently with MMC injection. Triamcinolone acetonide as well as MMC lowers scar proliferation.…”