1.Procedure and precautions for postoperative perfusion of bladder cancer Before perfusion – abstain from water 4h before treatment, or 1h after intravenous infusion to avoid excessive urine production in a short time and shorten the retention time of drugs in the bladder; empty bladder urine before perfusion to avoid dilution of drug concentration by residual urine in the bladder to reduce the efficacy.
During instillation – the patient should be placed in a flat or lithotomy position, observe aseptic operation, insert the urinary catheter, ask the patient to do deep breathing to relax the whole body, operate gently to avoid damaging the urethral mucosa, inject the drug slowly, the speed of pushing the drug should not be too fast to avoid stimulating the bladder to cause urination, observe and ask the patient if there is discomfort during the pushing process.
After instillation – After the drug is instilled into the bladder, the patient is instructed to lie down and rest in the left-sided, right-sided, supine and prone positions for about 10 min each to make full contact between the drug and the mucosal tissue of each bladder wall to ensure the efficacy of the drug. After the drug is retained in the bladder for 40 minutes, the patient discharges the drug independently and washes the perineum in time. Patients are instructed to drink more water after the drug is discharged to accelerate urine production, so that the concentration of the drug in the discharged urine is reduced and the stimulation of the drug to the urethral mucosa is reduced.
Pay attention to observe whether there are adverse changes such as urinary frequency, urinary urgency and hematuria 3 days after the drug is administered.
2.Program and follow-up of postoperative perfusion for bladder cancer Conventional program: 1 time per week for 10 times after surgery; change to 1 time per month for 2-3 years.
Suitable for: complete resection of tumor, no carcinoma in situ, negative postoperative urinary exfoliative cytology test.
Follow-up: Blood and urine routine and liver and kidney function are reviewed monthly in the pre-infusion period depending on the patient’s condition, and once every 2-3 months in the later period to monitor adverse drug reactions. Cystoscopy should be repeated every 3 months.
3.Common adverse reactions of bladder cancer perfusion therapy Urinary frequency and urgency Drug stimulates the submucosal nerve of bladder, which increases the sensitivity of bladder, resulting in urinary frequency and urgency. Do good psychological care for patients, relieve nervousness, encourage more water and urination, and continue perfusion therapy after symptoms are significantly reduced, or extend the interval of perfusion.
Hematuria is mostly caused by drug stimulation of bladder mucosa, instruct patients to drink more water after perfusion, wait until hematuria disappears and delay for 1 week, and continue bladder perfusion treatment after bladder mucosa repair.
Painful urination mostly occurs in patients with inflammation of the urethra or those who have recently had their urinary catheters removed after surgery. Patients with urinary tract infection should be treated with anti-inflammatory therapy before bladder irrigation.
Urethral stricture is mostly caused by repeated placement of catheters that damage the mucosa of the urethra.
When leukopenia reduces leukocytes <4×109/L, oral leukocyte-raising drugs can be taken; when leukocytes <3×109/L, treatment should be suspended and comprehensive therapeutic care should be actively taken to prevent infection.