Bladder Irrigation

Abstract: Automated flow cytometry (FCM) has been used to study saline bladder irrigation specimens from nearly 400 patients at Memorial Sloan-Kettering Cancer Center during the two-year period March 1979–March 1981. These include 36 patients with papilloma, 35 with noninvasive papillary transitional cell carcinoma, 71 with flat carcinoma in situ, and 52 with invasive carcinoma of the bladder, as well as 110 well patients with a history of low-stage bladder tumors (98 had two or more examinations) and 100 patients without neoplastic disease of the bladder. The false-positive rate for patients with normal bladders or non-neoplastic bladder diseases was 2% (two patients); both had severe cystitis and bladder calculi. The false-negative rate for the group with histologically proven tumors was 18%; excluding papilloma it was 7%. A FCM diagnosis of bladder tumor antedated the development of cystoscopically visible tumor by up to 12 months in 18 patients. Fourteen additional patients have positive FCM at present with or without positive conventional cytology and continue to be followed. These data suggest that FCM can provide an objective quantitative measure of the exfoliated epithelial cells in bladder irrigation specimens, and is at least as sensitive and specific as conventional urine cytology for the detection of cancer cells. An interpretation of each specimen is recorded on a computer-generated hard copy replica of the two-dimensional scattergrams, or pseudo-three-dimensionl projection of the data and used by the clinician as a permanent report of that specimen. FCM has a practical application in the detection and diagnosis of bladder carcinoma among subjects at high risk, and is of value in monitoring the course of this disease and anticipating recurrence following conservative treatment.

Abstract: Management of the superficial bladder cancer patient consists of two complementary but separate therapeutic goals: treatment of the existing tumor(s) and prevention of tumor recurrence. At present, the stage, grade, and multicentricity are the major determinants in the natural and therapeutic history of the disease. Although intravesical instillation of chemotherapeutic agents has been used for greater than 20 years, neither its exact role nor the optimal dose or schedule of administration have been established. To date, no dramatic differences in efficacy between the agents commonly used for intravesical chemotherapy, either as definitive therapy or prophylaxis, have been appreciated. These agents do appear to lower the recurrence rate as well as extend the disease-free interval. Since the most thorough experience is with thiotepa, it is the drug against which other agents should be compared in terms of both efficacy and toxicologic evaluation. Different administration schedules and methodologies need further study, such as the utility of continuous bladder irrigation, the use of sequential chemotherapeutic agents to gain cell synchronization, and the use of multiple drug regimens. Because there are multiple factors that influence the occurrence and recurrence of bladder cancer, combined modality therapy deserves testing. Modes of therapy that could be used together because they act through different mechanisms are intravesical chemotherapy, radioactive needle implants, carcinogen modifiers such as pyridoxine, chemoprotective agents such as retinoic acid, and immune stimulants such as BCG. These studies should be performed in a randomized prospective controlled fashion, which may require cooperative multi-institutional involvement to accrue adequate numbers of patients. At this time there are a number of important questions that remain to be answered concerning the treatment of superficial bladder cancer: (1) does this mode of therapy affect overall survival, (2) does prophylactic intravesical chemotherapy alter the incidence of subsequent muscle invasive disease, (3) does intravesical chemotherapy alter the sites, incidence, or responsiveness to systemic chemotherapy of subsequent metastatic disease, and (4) and what is the optimal timing and duration of prophylactic therapy from a cost-effectiveness standpoint?

Abstract: PURPOSETo compare the use of intravenous (IV) hydration plus either continuous bladder irrigation or mesna for the prevention of hemorrhagic cystitis in the bone marrow transplant setting.PATIENTS AND METHODSTwo hundred patients were prospectively randomized to receive either continuous bladder irrigation with 200 mL/h of normal saline, or continuous infusion mesna at 100% of the cyclophosphamide dose.RESULTSThe overall incidence of hematuria of any grade was significantly higher in the bladder-irrigation group (76%) compared with the mesna group (53%) (P = .007). However, the incidence of grade III and IV hematuria was the same in both groups (18%; P = NS). Moderate or severe discomfort or bladder spasms were reported in 84% of the patients who received bladder irrigation, compared with 2% of the patients who received mesna prophylaxis (P < .0001). Urinary tract infections (UTIs) were documented in 27% of the patients in the bladder-irrigation group, compared with 14% of the patients in the mesna group (...