Patient: I just had a transurethral resection and I feel fine now. What is the best medication to instill after the resection, piroplasin or BCG or mitomycin? If I use BCG vaccine, is it the same kind of BCG vaccine that children get for vaccination?
Ye Dingwei, Department of Urology, Shanghai Cancer Hospital: There are many kinds of drugs for post-electrolysis perfusion treatment of bladder cancer, mainly divided into two categories, one is immune agents, including BCG vaccine, interferon, interleukin, etc., and the other is chemotherapy drugs, such as piroplasin, epirubicin, mitomycin C, etc. From the current research results, BCG is preferred for the perfusion treatment of in situ cancer and some highly malignant superficial bladder cancer, but there is no very regular perfusion with BCG in China for some reasons. Therefore, chemotherapeutic drugs are mainly used in clinical practice at present. The latter is basically close to the efficacy of BCG for most superficial bladder cancers. BCG is currently used in China mainly for the prevention of tuberculosis in infants and children, but the dose is obviously very different from that used for bladder irrigation.
Patient: Thank you for your detailed explanation, I appreciate it. I would also like to ask if radiotherapy is needed after electrosurgery for grade 3 uroepithelial carcinoma of the bladder? The doctor in our local hospital said that if radiotherapy is given now, it will be difficult to treat if it comes back later. Thank you so much ！！！！！
Ye Dingwei, Department of Urology, Shanghai Cancer Hospital: The level of bladder cancer is not necessarily related to the need of radiotherapy. Radiotherapy is currently only applicable to muscle-infiltrating bladder cancer and is not as effective as total bladder surgery. Like your bladder uroepithelial carcinoma grade III, which is the highest grade of bladder cancer, in other words, the tumor is of high malignancy. If the tumor does not invade the muscular layer, you also need to undergo another electrosurgery 4-6 weeks after the initial electrosurgery. If the muscle layer is invaded, total bladder resection is preferred. The re-electrolysis is much more important than your irrigation!
Patient: I am really grateful to Director Ye for his careful answers, and I feel the true heart of a doctor only after I am sick. I don’t know how deep the infiltration is, how can I know if there is any invasion of the muscular layer, and if the second electrodes are removed, is it 4-6 weeks after surgery or is it cystoscopic review before the second electrodes are removed? I don’t know how long you think it is appropriate to review the cystoscopy after surgery, 1 month or 3 months, but the surgeon here said 3 months for cystoscopy review, is it too late? I don’t dare to disturb you too much, but I’d like to reply at a convenient time, thank you very much!
Ye Dingwei, Department of Urology, Shanghai Cancer Hospital: We suggest that the second cystoscopy should be done 4-6 weeks after the first cystoscopy to determine whether there is recurrence.