Relationship between Preoperative Pyuria and Bacille Calmette-Guerin Treatment in Intravesical Recurrence after Transurethral Resection of High-Risk, Non-Muscle Invasive, Bladder Carcinoma: A Retrospective Study of Human Data

Abstract

Some researchers have found that preoperative pyuria is a risk factor for recurrence after transurethral resection of high-risk non-muscle invasive bladder cancer. However, to our knowledge, none have clarified the risks associated with pyuria according to bacille Calmette-Guerin (BCG) treatment status. We retrospectively selected patients with high-risk non-muscle invasive bladder cancer according to Japanese Urological Association guidelines. Pyuria was defined as ≥10 white blood cells per high-powered field. We analyzed recurrence-free rates (RFS) in 424 patients who had and had not undergone BCG treatment. The median duration of follow-up was 45.2 months. According to multivariate analysis, postoperative intravesical BCG induction and preoperative pyuria were independent risk factors for intravesical recurrence in the whole study cohort. We found no significant risk factors for recurrence in the BCG-treated group (n = 179). In the non-BCG-treated group (n = 245), patients with pyuria were much more frequently female and more often had T1 disease than patients without pyuria. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. There was no significant difference in the severity of pyuria between the BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk NMIBC and pyuria.

Association Between Residual Urine Volume and Recurrence Among Patients at High Risk of Non-Muscle-Invasive Bladder Carcinoma With Versus Without Bacillus Calmette-Guérin Treatment

“…As a result, we speculate that tumor dissemination is more likely to occur within the bladder of patients with a large residual urine volume than in those with a small residual urine volume. The presence of pyuria is also reportedly an independent risk factor for poor RFS in patients with BC [ 13 , 29 , 30 ]. Furthermore, prolonged exposure of the mucous membranes to urine-containing BC cells is thought to cause inflammation and may promote dissemination.…”

“…This previous study showed that the presence of residual urine may be a risk factor for intravesical recurrence in patients with all levels of NMIBC risk. The presence of pyuria is also an independent risk factor for recurrence [ 12 , 13 ]. Therefore, in patients with mucous membranes that are inflamed before TUR, a constant state of residual urine volume that persists after TUR may promote the engraftment of BC cells after surgery, resulting in a higher recurrence rate.…”