Initial study on a comprehensive strategy for female patients with bladder pain syndrome / 现代泌尿外科杂志

【Objective】 To explore the efficacy of a comprehensive treatment strategy of bladder hydrodistension, transurethral resection of bladder lesions and triple drug instillation in patients with painful bladder syndrome (BPS). 【Methods】 A total of 15 female BPS patients treated during Jan.2020 and Oct.2021 were enrolled. All patients received bladder hydrodistension and transurethral resection. After operation, intravesical instillation of a triple-drug mixture (2% lidocaine hydrochloride 20 mL, heparin sodium 25 000 U, and dexamethasone 10 mg) was administered once a day for 5 days, and then once per week for 4 weeks. The Visual Analogue Scale (VAS) score, quality of sexual life, health-related quality of life, and self-rating anxiety scale score were compared before treatment and 1, 4 and 12 weeks after treatment. The complications were recorded. 【Results】 All patients completed the treatment. Of 14 patients, the VAS score and self-rating anxiety scale score were lower in week 1, 4 and 12 after treatment, while the health-related quality of life score increased. One patient’s symptoms remained unchanged. The VAS score decreased from (5.47±1.81) to (1.87±1.51) (P<0.05), and the self-rating anxiety scale score decreased from (18.13±8.64) to (6.33±8.22) (P<0.05). The score of health-related quality of life increased from (24.47±5.41) to (31.53±6.49) (P<0.05). 【Conclusion】 The comprehensive strategy is effective in the treatment of bladder pain syndrome, which can relieve pain symptoms and improve patients’ quality of life.

Expert consensus on intravesical therapy for non-muscle invasive bladder cancer (2021 edition) / 中华肿瘤杂志

Bladder cancer is one of the common malignant tumors in China, with 75% of bladder cancer being non-muscle invasion with a high recurrence rate after surgery. Intravesical therapy is an useful methods to either directly kill tumor cells by infusing cytotoxic drugs into the bladder or directly or indirectly induce local immune responses of the body through infusing immune agents, such as bacillus calmette guerin, and thus reduce the risk of tumor recurrence and progression. In 2019, the Urological Chinese Oncology Group issued the "Expert consensus on intravesical therapy on non-muscle invasive bladder cancer" . Recently, great progress in the clinical diagnosis and treatment of non-muscle invasive bladder cancer has been achieved domestically and abroad, including the risk assessment of non-muscle invasive bladder cancer, the therapeutic choice of intravesical drugs, the adverse reactions and treatment experience of intravesical therapy, and clinical research on new types of intravesical drugs. This consensus is made according to domestic and overseas evidence-based medicine in combination with current clinical practice and experience of intravesical therapy for non-muscle invasive bladder cancer in China. It is an update of the 2019 expert consensus, with the wish to provide a guidance for domestic clinical standardized intravesical therapy for non-muscle invasive bladder cancer.

Management of BCG Failures in Non-Muscle-Invasive Bladder Cancer

PURPOSE: Bacillus Calmette-Guerin (BCG) intravesical therapy is the standard treatment in high-risk patients with non-muscle-invasive bladder cancer, but a significant number of patients experience recurrence after BCG therapy. Although several treatment options are available for recurrence after BCG therapy, the optimal treatment strategy is still controversial. We reviewed current and promising treatment options after BCG failure. MATERIALS AND METHODS: search of published literature using PubMed and meeting abstracts was performed. RESULTS: BCG failures are further subdefined as BCG refractory, BCG resistant, BCG relapsing, and BCG intolerance. Several predictors for BCG response have been studied, but prediction or stratification before therapy seems to be difficult in clinical practice. Novel biomarkers associated with immunologic mechanisms appear to be promising to predict BCG failure. Radical cystectomy is the standard treatment for BCG-refractory disease, but the timing of cystectomy is controversial. BCG maintenance or combination with interferon-alpha is a promising therapy for BCG resistance or relapse. Some salvage therapies or device-assisted instillations have been also promising, but the efficacy and safety of these novel therapies should be confirmed by large prospective studies before their clinical use in BCG failure. CONCLUSIONS: Patients with BCG failure are not a homogeneous group and need to be stratified. Radical cystectomy should be performed without delay in patients with BCG-refractory status, but salvage intravesical therapies may be an alternative in cases without true refractory status. Although BCG and interferon intravesical therapy is promising, more efficient salvage therapy after BCG failure is required.

A Comparison of Prophylactic Efficacy of Intravesical Instillation with Bacillus Calmette-Guerin and Thiotepa in Superficial Bladder Cancer / 대한비뇨기과학회지

We compared the prophylactic efficacy of intravesical BCG with thiotepa instillation after complete removal of superficial bladder cancer. Forty patients received BCG and 32 received thiotepa. The mean followup period was 29 months in BCG group, and 34 months in thiotepa group. The overall recurrence rate was 35% in BCG group compared with 53% in thiotepa group, showing difference statistically(p0.05). The overall recurrence index per 100 patient-months was also lower for the BCG versus the thiotepa group(1.21 versus 1.56, p>0.05). One patient in the BCG group and 4 in the thiotepa group had recurrent tumors with progression in stage. Side effects were irritative voiding symptoms(100%), fever and chills(10%), and inguinal lymphadenitis(2.5%) in BCG group, while irritative voiding symptoms(25%), fever and chills(6.3%), and myelosuppression (6.3%) in thiotepa group. Our results suggest that BCG is significantly superior to thiotepa in reducing bladder tumor recurrence and in retarding tumor progression.

A comparison of mitomycin C and bacillus calmette-guerin for the prophylaaxis of high risk superficial bladder tumors / 대한비뇨기과학회지

We compared the prophylactic efficacy of intravesical mitomycin C with bacillus Calmette-Guerin instillation in the high risk superficial bladder tumor patients. Recurrent, grade III multiple (more than 3) or large(more than 3 cm) stage Ta or T1 tumors were included. Thirty patients were treated with 8 weekly instillation of 40mg of mitomycin C and 31 with 6 weekly instillation of 120mg or BCG. Thirty six patients were selected as a control Group. The mean follow-up period was 31.3 months in BCG, 27.7 months in mitomycin C and 23.2 months in control group. The overall one and two year recurrence rate was 52% and 62% in BCG, 70% and 80% in mitomycin C and 74% and 82% in control group. which was not statistically different(p>0.05) and the recurrence free pattern among three groups was not different statistically. But the mean time for recurrence and time for recurrence of 50 percent of the patients was 24.55 and 13 months in BCG group, which were longer than 14.2 and 5 months in mitomycin C and 12.72 and 7 months in control group. The tumor grade and number were lowered in the 20 recurrent tumors after BCG treatment with statistical significance. The overall 2 year recurrence rate was not significantly improved, BCG instillation resulted in improvement in grade, decrease in the number of the tumor and delay in time for recurrence in patients with high risk superficial bladder tumors. Although prophylactic efficacy of the BCG instillation is not complete, it would be provide reasonable benefit to the patients and is apparently superior to mitomycin C.