Two different protocols in single, immediate, postoperative intravesical chemotherapy after transurethral resection in suspected, low-risk, non-muscle-invasive bladder cancer.

Purpose: To evaluate different protocols to increase the efficacy and reliability of single, immediate intravesical postoperative chemotherapy (IPOC) after transurethral bladder tumour resection (TURBT).

Methods: A retrospective evaluation was made of 104 patients, who underwent TURBT between October 2020 and October 2022, and were subsequently administered IPOC. The patients were examined in two groups as infusion IPOC (n:50) and bolus IPOC (n:54). In the infusion IPOC group, 50 mg epirubicin in 100 mL saline was administered intravesically in 30 min as an infusion with gravity. In the bolus IPOC group, 50 mg epirubicin in 50 mL saline was administered intravesically as a bolus with a catheter-type syringe. Preoperative information was recorded, including age, gender, body mass index (BMI), ASA score, smoking status, primary tumour, and previous IPOC, and postoperative information, including number, size, stage, and grade of tumour, the presence of detrusor muscle in the specimen, prognostic risk group, and second TURB. The two groups were compared with respect to dysuria, urgency, pain (VAS score), IPOC discontinuation, tumour recurrence rate, and recurrence-free survival (RFS).

Results: No statistically significant difference was determined between the groups with respect to age, gender, BMI, ASA score, smoking status, presence of primary tumour, number and size of tumours, the presence of detrusor muscle in the specimen, stage and grade of tumour, prognostic risk group, second TURB, and previous IPOC (p > 0.05 for all). The VAS score for pain/bladder irritation was determined to be statistically significantly lower at 2.3 ± 1.8 in the infusion IPOC group compared to 3.1 ± 2.2 in the bolus IPOC group (p = 0.01). The discontinuation rate of 10.0% was statistically significantly lower in the infusion IPOC group compared to the 25.9% rate determined in the bolus group (p = 0.04). Although the RFS rate was higher in the infusion IPOC group in all the NMIBC patients (p = 0.4) and in the low-risk NMIBC subgroup (p = 0.1), no significant difference was found. In the low-risk NMIBC, the 3-month recurrence rate was 3.3% in the infusion IPOC group and 20.5% in the bolus group, and thus the infusion protocol was observed to have significantly reduced early recurrence (p = 0.04).

Conclusion: The results of this study showed that an infusion IPOC protocol demonstrated reliability, efficacy, and applicability, which decreased bladder irrigation and treatment discontinuation rates while also reducing early recurrence.