Open Access

ARTICLE

Bladder irrigation after transurethral resection of superfcial bladder cancer: a systematic review of the literature

Amr Mahran^1,2, Laura Bukavina^1,2, Kirtishri Mishra^1,2, Christina Buzzy^1,2, Morgan L Fish¹, Aidan Bobrow¹, Lee Ponsky^1,2,3

1 University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, USA
2 Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
3 Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Address correspondence to Dr. Lee Ponsky, University HospitalsClevelandMedicalCenter,11100EuclidAve,Lakeside Bldg # 4954, Mailstop LKS 5046, Cleveland, OH 44106 USA

Canadian Journal of Urology 2018, 25(6), 9579-9584.

Abstract

Introduction: The vast majority of bladder cancer is non-muscle invasive with transurethral resection (TURBT) as the gold standard for surgical treatment. There is a high recurrence of bladder cancer post-surgery, which adds to the frustration in current urologic practice. Current standard of care to further reduce bladder cancer recurrence is instillation of intravesical chemotherapy (ICT), a practice that is not routinely followed. Several studies point to similar effects with normal saline or water irrigation alone. Our objective is to review the current available literature and provide practicing urologists with an alternative to ICT.
Materials and methods: A systematic search was performed through December 2017. Peer reviewed studies, which evaluated recurrence free survival (RFS) after bladder irrigation with saline or sterile water (SW) post-TURBT were included. Outcomes were analyzed in three groups: ICT, saline, and sterile water.
Results: Six studies out of 981, including 1515 patients, were eligible. There was no significant difference between ICT, saline, and SW groups regarding the median RFS at 1 year [ICT: 81%, IQR (77.70, -81.00), SW: 74%, IQR (63.3-74.9), saline: 76.7% IQR (76.0, 77.7), p = 0.21]. While saline irrigation showed the highest median RFS among the groups, there was no statistically significant difference between the three groups [ICT: 70%, IQR (66.25, 73.75), SW: 64.1%, IQR (63.05, 65.15), saline: 73%, IQR (66.85, 74.50), p = 0.49]. Adverse events were more frequent amongst patients in the ICT group in comparison to the saline or water groups.
Conclusion: Saline and sterile water irrigation provide an alternative to ICT with equivalent recurrence rate and lower incidence of adverse events.

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