(UroToday.com) The 2024 South Central AUA annual meeting included a session on lower genitourinary tract cancer, featuring a presentation by Clare Weiland discussing whether the use of continuous bladder irrigation after trans urethral resection of bladder tumor (TURBT) increases the risk of complications. In the United States, bladder cancer is the fourth most common malignancy and eighth most common cancer risk deaths among men. The diagnosis and treatment of bladder cancer involves a TURBT, with hemostasis usually confirmed in the operating room.
However, patients may experience postoperative hematuria, prompting the use of continuous bladder irrigation to control the bleeding. There is a paucity of literature assessing the risk of complications for the use of continuous bladder irrigation following TURBT. This study presented at the 2024 South Central AUA annual meeting aimed to establish possible risks factors and incidence of post-operative complications associated with continuous bladder irrigation following bladder tumor resection.
Data on patients who underwent TURBT were abstracted from electronic medical records at CHI Hospitals in the Omaha, Nebraska metropolitan area from 2018-2022. Log-binomial models were estimated to evaluate whether continuous bladder irrigation, use of blood thinners, history of smoking, and a previous resection were associated complications following TURBT. Interaction effects were estimated to assess whether a previous resection, previous bladder tumors, an invasive stage, use of blood thinners, or history of smoking moderated the effect of continuous bladder irrigation on the odds of complication. To account for the inherent correlation of visits from the same patient the investigators estimated random subject effects.
There were 92 visits where a patient underwent TURBT: 34 received continuous bladder irrigation in the operating room and 7 received continuous bladder irrigation post-operation. Table 1 presents patient characteristics with no notable differences between the two groups:
The visit characteristics are as follows, highlighting that those undergoing continuous bladder irrigation had a longer length of stay:
No postoperative bladder perforations occurred. Receiving continuous bladder irrigation was associated with 3.0 times greater odds of complication (continuous bladder irrigation: 16.14%, no continuous bladder irrigation: 36.88%, 95% CI: 1:02-9.04). Interaction effects of continuous bladder irrigation with variables including previous resection, history of bladder tumor, tumor staging, blood thinners, and smoking history were not significant. Blood thinners were associated with 10.6 times greater odds of complication following TURBT (yes: 51.05% versus no: 8.93%, 95% CI: 3.01-37.54). Smoking history and previous resection were not associated with complications (smoking OR: 0.74, 95% CI 0.24-2.22, resection OR: 0.36, 95% CI 0.09-1.44).
Clare Weiland concluded her presentation discussing whether the use of the continuous bladder irrigation after TURBT increases the risk of complications with the following take-home points:
- Receiving continuous bladder irrigation following TURBT was associated with increased odds of complication
- Irrespective of continuous bladder irrigation, using blood thinners was associated with increased odds of complications after TURBT, while history of smoking and previous resection was not
- Understanding the risk of complications for patients undergoing continuous bladder irrigation after TURBT could help guide decision making for postoperative continuous bladder irrigation use
- Further investigations with a larger sample size would be necessary to better inform clinical practice
Presented by: Clare M. Wieland, MD Candidate, Creighton University, Nebraska, NE
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 South Central American Urological Association (AUA) Annual Meeting, Colorado Springs, CO, Wed, Oct 30 – Sat, Nov 2, 2024.