SIU 2017: Is Re-Implantation Theory True: Post Operative Drainage Tool for Bladder is a Risk Factor of Recurrence in Low Risk Bladder Tumor?

Lisbon, Portugal ( Low-risk pTa TCC is a common presentation of bladder urothelial carcinoma – and while it has low risk of progression, it has a very high rate of recurrence. Likely due to a field defect in the mucosa, there has also been discussion of an implantation theory – disruption of tumor during TURBT leads to free floating TCC cells, which implant in other areas of the bladder, leading to recurrence.

While others have addressed this with intravesical chemotherapy management to help reduce recurrence, and in theory bathe the urothelial with chemotherapy and treat potentially dislodged cancer cells, the authors of this study focus more on a different technique. Rather than using a traditional 2-way indwelling foley catheter, which only drains, they hypothesized that a 3-way irrigation foley with continuous bladder irrigation (CBI) post-TURBT may help prevent tumor implantation.

To that effect, they completed a retrospective study on 74 patients with a primary single-site 

LG Ta bladder cancer <3 cm in size that was completely resected between 2000 and 2015. Complete TURBT was attempted and completed in all patients. There were two groups in the retrospective cohort, separated by type of catheter drainage. Those with CBI were maintained on CBI for a period of time that was unspecified. Cystoscopic recurrence per protocol q3months was used to assess for recurrence. 

Mean age was 64, 2/3 were smokers in each group, and both had a catheter for 1.5 days. 33 patients were drained by 2-way foley, while 41 patients were drained by 3-way irrigation catheter. 

In terms of outcomes, recurrence rates were similar in both groups – 21% vs. 19%. With a median follow-up between 26-28 months, the mean time to recurrence was slightly different – 7 months (irrigation) or 11 months (no irrigation). They reported that this was not significant, but no statistics were provided. They do state tumor size was a significant predictor of recurrence.

They conclude that irrigation with 3-way foley was no different that passive drainage with 2-way foley. However, their data may suggest earlier recurrence with irrigation. Unfortunately, the methodology is not great, significantly limiting the value of these results. Greater standardization is needed, and preferably even a prospective study. Selection bias is a critical flaw to this paper.

Presented by: Sami Ben Rhouma
Affiliation: La Rabta Hospital, Tunisia

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal