The current standard of care for non-muscle-invasive bladder tumors includes transurethral resection of bladder tumors (TURBT) with bladder irrigation therapy. In general, bladder perfusion therapy has few or only minor treatment-related complications.
Complications associated with bladder irrigation therapy mainly include local and systemic complications.
[Perfusion operation complications and treatment].
1, Timing of perfusion: It is currently recommended that the first bladder chemotherapy irrigation should be completed within 24 hours after the electrodesiccation procedure.
2.The principle of aseptic operation should be strictly observed during bladder chemotherapy perfusion.
3.The use of F8-10 disposable catheter is appropriate for chemotherapy irrigation. Local anesthesia and adequate lubrication of the urethra should be given during irrigation to reduce the patient’s discomfort and to relax his urethral sphincter.
4. The effect of perfusion therapy and the appearance of complications are also related to the dose and concentration of the drug and the maintenance time of perfusion.
[Perfusion therapy of BCG].
1.Local side effects: The local side effects of BCG infusion are still mainly cystitis.
2, systemic side effects: a small amount of BCG absorption, can be manifested as low fever, night sweats, muscle aches and other mild symptoms of tuberculosis infection, may be accompanied by bladder irritation symptoms, in general these symptoms can appear 2-3 days after infusion, most of them can be relieved by themselves, if systemic symptoms persist or appear high fever and other manifestations, to consider giving timely anti-TB treatment.
For the above complications after BCG instillation, the original instillation regimen can still be considered to be maintained after active treatment of the symptom relief, but for patients with systemic side effects, re-infusion should ensure healing of the bladder and urethral trauma.
Perfusion therapy with epirubicin]
Epirubicin is a more commonly used bladder chemotherapy instillation agent, which is a derivative of adriamycin. The incidence of systemic side effects of epirubicin infusion is relatively rare, and the incidence reported by several clinical centers is <1%, mainly manifesting as nausea, poor appetite, and decreased white blood cells after infusion, and rarely showing cardiotoxicity, and the systemic side effects are generally mild and not long-lasting, and can be treated with appropriate symptomatic treatment.
[Mitomycin C infusion therapy].
Mitomycin belongs to antimicrobial chemotherapy drugs, and is the most widely used bladder chemotherapy infusion drug in clinical practice. When infusing mitomycin, great care should still be taken not to let the drug come into contact with the skin, and patients should wash the perineum promptly after urination after infusion.
Cetepe infusion therapy]
Cetepe is an alkylating agent antitumor drug, which has a long history of application in the perfusion treatment of bladder tumors. It is relatively inexpensive and has a significant effect in preventing tumor recurrence, and therefore is the only chemotherapy drug approved by the FDA for bladder cancer perfusion.
New chemotherapeutic agents for perfusion therapy]
The so-called new chemotherapeutic agents used for bladder tumor perfusion therapy are mainly referred to gemcitabine and docetaxel, among which the effect of gemcitabine for intravenous chemotherapy for bladder cancer has been confirmed.
【Observation points after treatment】.
The vast majority of post-perfusion bladder complications are reversible, with very few reports of long-term complications. We recommend that after controlling the symptoms of post-perfusion complications, the cause of the complication should be carefully analyzed, especially to distinguish whether it is a chemical or bacterial cystitis. If the perfusion complication is caused by the perfusion drug itself, then changing to another drug is a good option if conditions allow. While in dealing with complications, generally 1-2 degrees of side effects can not affect the normal course of treatment if there are no special ones, and in case of 3 degrees or more complications, it is better to suspend treatment and continue after recovery. For some patients with hematuria performance, we should first pay attention to whether there may be tumor recurrence, and then can be considered as side effects of chemotherapy after exclusion.
Key points of doctor-patient communication
Currently, bladder perfusion is the most effective treatment to prevent tumor recurrence and progression, and the clinician will give the corresponding perfusion plan according to the different risk of tumor recurrence and progression.
Most of the side effects can be relieved by themselves, and a few patients with more serious degree can recover gradually after stopping the drug, and very few irreversible side effects can occur.
3. Hematuria and fever may often occur after infusion therapy, and if they are severe, the treating physician should be contacted promptly to avoid aggravation of the side effects that cannot be treated.
The use of certain drugs may lead to some special side effects, which should be brought to the attention of patients, such as the use of Setipec should be tested on time blood picture, the use of Gemcitabine need to observe the changes in renal function, the use of mitomycin may cause allergic dermatitis, etc.