Comparison of sterile water irrigation versus intravesical mitomycin C in preventing recurrence of nonmuscle invasive bladder cancer after transurethral resection

Abstract

Introduction:Early recurrence of nonmuscle invasive bladder cancer (NMIBC) following transurethral resection (TUR) remains relatively high. An immediate single instillation of mitomycin C (MMC) reduces the recurrence rates in the first 2 years but has not shown benefits in tumor progression or overall survival. Distilled water irrigation has shown to delay tumor recurrence by osmolysis of tumor cells. There are only limited clinical studies comparing the efficacy of MMC with continuous sterile water irrigation (CSWI) in preventing the recurrence of NMIBC after TUR in clinical setting.Materials and Methods:A prospective, randomized, open-label, two-arm, single-center, pilot study was conducted between December 2013 and September 2015 at a tertiary-care center in South India. Patients were randomized into CSWI group (n = 19) or single dose intravesical MMC group (n = 17) following TUR for NMIBC and analyzed. All patients were followed up with flexible cystoscopy and urine cytology at 3 months interval for 1 year. Recurrence-free rate was estimated as the primary criterion for outcome analysis.Results:At the end of 12 months, recurrence-free rates for MMC and CSWI groups were 47.1% and 52.6%, respectively. The mean recurrence-free interval for MMC and CSWI groups were 10.9 months and 9.8 months, respectively. The difference in recurrence-free rate or recurrence-free interval between two groups was statistically nonsignificant. Further, the complications in MMC group were significantly higher than that in CSWI group (P = 0.047).Conclusions:Continuous bladder irrigation with sterile water after TUR may be comparable to immediate single dose intravesical MMC in preventing tumor recurrence in NMIBC.

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

“…Our findings have some clinical implications. First, although several studies reported no significant difference in time to IVR between patients treated with CSBI alone and those treated with SIC ( 9 , 10 , 18 ), our results suggest that CSBI can weaken the inhibitory effect of SIC on IVR if it is performed after SIC. Second, irrigation with saline and DXR, which included a low concentration of DXR, did not exert an anticancer effect, meaning that CSBI alone could not have a preventive effect on IVR.…”

“…In contrast, earlier reports suggested that CSBI had a greater preventive effect on IVR compared to SIC ( 9 , 10 , 18 , 19 ). One report showed that there were no significant differences in the median time to first recurrence between patients treated with CSBI and those who underwent immediate SIC with mitomycin C ( 9 ).…”

“…One report showed that there were no significant differences in the median time to first recurrence between patients treated with CSBI and those who underwent immediate SIC with mitomycin C ( 9 ). Another study revealed that CBSI with sterile water after TURBT might have the same preventive effect on IVR as an immediate single dose of intravesical mitomycin C in patients with NMIBC ( 18 ).…”

Comparison of Efficacy and Safety Between Postoperative Intravesical Instillation of Mitomycin-C and Continuous Saline Bladder Irrigation after TURBT in Non-muscle Invasive Bladder Cancers

“…In a prospective, randomized, open-label, singlecentre, two-arm pilot study between an immediate MMC instillation after TURBT and sterile water irrigation (CSWI) was undertaken between December 2013 and September 2015 with 19 patients in CSWI group and 15 patients in MMC group. 19 After 12 months, recurrence-free rates were 52% for CSWI group and 47.1% in MMC group. The mean recurrencefree period for CSWI group was 9.8 months and for MMC group 10.9 months.…”

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“…In a randomized controlled trial, Bijalwan et al . [ 7 ] compared continuous irrigation with sterile water to a single intravesical mitomycin C instillation and detected no significant difference.…”