Increasing patient comfort by optimized postoperative administration of intravesical mitomycin C.

Abstract

To report a prospective controlled study to compare the acceptance of two different ways of administering intravesical mitomycin C, as the immediate intravesical administration of chemotherapy after surgery decreases the risk of recurrence in patients with superficial bladder cancer, but response rates are variable, partly because of inadequate drug delivery and thus an adequate administration time is important for optimum oncological efficacy.
Between October 2004 and June 2005, 60 patients were divided after transurethral resection of superficial bladder cancer into two groups. Both groups received an intravesical instillation of 40 mg mitomycin C diluted in 40 mL distilled water at <or=6 h after surgery. In group A the catheter was clamped; in group B the catheter was not clamped but the urine bag was elevated to 1 m above the level of the supine patient to enable bladder contractions with no rigid resistance, and mitomycin C was retained within the bladder by hydrostatic pressure. Discomfort and pain were documented by the patient every 15 min. The instillation was terminated after 2 h, or earlier if the pain was not tolerable. The relapse rate during the follow-up was also recorded.
Histology and the number of tumours resected was not significantly different between the groups. In group A the mean (SD, range) instillation time was 83.4 (3.1, 15-120) min and 11 (37%) patients tolerated all 120 min of treatment. The instillation time in group B was 110.4 (20.9, 60-120) min and 25 (83%) patients completed 120 min. The mean (SD) overall pain levels measured were significantly lower (P <or= 0.05) in group B, at 2.7 (2.4) in group A and 1.8 (1.3) in group B. There was no remarkable difference between the groups in recurrence rates.
Elevation of the urine bag instead of clamping the catheter was associated with a significantly longer instillation, more patients completing the full 2 h of treatment and significantly lower pain sensations. There was no remarkable difference in the groups in recurrence rate during the follow-up, but this might be because there were few patients in this pilot study.