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A Phase 2 Pilot Study of Water Irrigation After Transurethral Resection of Bladder Tumor (WATIP) Demonstrating Safety, Feasibility and Activity - Beyond the Abstract

The underutilisation of immediate post-operative instillation of intravesical chemotherapy to reduce recurrences of non-muscle invasive bladder cancer after transurethral resection (TURBT) remains a significant and widespread problem.1-3 The latest guidelines from the European Association of Urology have incorporated a recommendation for continuous bladder irrigation to be utilised when intravesical chemotherapy is not feasible.

This recommendation is based on recent systematic reviews and meta-analyses of the literature.4-6 However, it is important to note that, even though published studies have shown comparable outcomes between continuous bladder irrigation and intravesical chemotherapy, they are generally small and likely underpowered to demonstrate potential clinically significant differences. Additionally, they have typically utilised 18 to 24 hours of irrigation, which would preclude day-case management which is typical for many TURBT cases.

Our pilot study7 establishes the feasibility and safety of 3 hours of water irrigation following TURBT and demonstrates 12-month recurrence-free rates that again appear comparable to intravesical chemotherapy. Compared to intravesical chemotherapy, water irrigation is likely to be cheaper and easier to deliver in most practice settings and have significantly fewer adverse effects. These benefits may offset marginally lower effectiveness in terms of prevention of recurrence, especially if broader and routine uptake can be achieved. Further comparative assessment of 3 hours of water irrigation compared to immediate post-resection intravesical chemotherapy is desirable to establish the clinical applicability of this intervention.

Written by: Shomik Sengupta, FRACS, MS, MD, Department of Urology, Eastern Health and Eastern Health Clinical School, Monash University

References:

  1. Choo SH, Nishiyama H, Kitamura H, Chen CH, Pu YS, Lee HL, et al. Practice pattern of non-muscle invasive bladder cancer in Japan, Korea and Taiwan: A Web-based survey. International journal of urology : official journal of the Japanese Urological Association. 2019;26(12):1121-7.
  2. Cookson MS, Chang SS, Oefelein MG, Gallagher JR, Schwartz B, Heap K. National practice patterns for immediate postoperative instillation of chemotherapy in nonmuscle invasive bladder cancer. The Journal of urology. 2012;187(5):1571-6.
  3. Palou-Redorta J, Roupret M, Gallagher JR, Heap K, Corbell C, Schwartz B. The use of immediate postoperative instillations of intravesical chemotherapy after TURBT of NMIBC among European countries. World journal of urology. 2014;32(2):525-30.
  4. Li M, Toniolo J, Nandurkar R, Papa N, Lawrentschuk N, Davis ID, et al. Continuous bladder irrigation after transurethral resection of non-muscle invasive bladder cancer for prevention of tumour recurrence: a systematic review. ANZ journal of surgery. 2021;91:2592-98.
  5. Mahran A, Bukavina L, Mishra K, Buzzy C, Fish ML, Bobrow A, et al. Bladder irrigation after transurethral resection of superficial bladder cancer: a systematic review of the literature. The Canadian journal of urology. 2018;25(6):9579-84.
  6. Zhou Z, Zhao S, Lu Y, Wu J, Li Y, Gao Z, et al. Meta-analysis of efficacy and safety of continuous saline bladder irrigation compared with intravesical chemotherapy after transurethral resection of bladder tumors. World journal of urology. 2019.
  7. Li M, Nandurkar R, Toniolo J, Davis ID, Sengupta S. A phase 2 pilot study of water irrigation after transurethral resection of bladder tumor (WATIP) demonstrating safety, feasibility and activity. World journal of urology. 2024;42(1):115.

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