1.What is bladder infusion chemotherapy? Bladder infusion chemotherapy is a kind of intracavitary chemotherapy. The doctor uses a catheter to inject chemotherapy drugs into the bladder and retains them for a certain period of time, and then the patient naturally drains the urine to complete. The retention time varies from drug to drug, but it should be noted that the retention time should be strictly in accordance with the instructions so as to achieve the best efficacy of drug infusion. 2.Why should bladder perfusion chemotherapy be performed after bladder cancer surgery? Bladder tumors are multifrequent, and the so-called multifrequency has two meanings. One meaning is manifested in spatial multiplicity; multiple tumors growing in the bladder at the same time. The other meaning is multiple in time. A large number of clinical studies have confirmed that the recurrence rate of non-muscle invasive bladder cancer using transurethral bladder tumor elective resection without subsequent bladder perfusion therapy is about 70-80% within 5 years. The main reasons for recurrence are: (1) the primary tumor is not excised; (2) the tumor cells are shed and implanted during surgery; (3) it originates from the pre-existing metastatic epithelial proliferation or atypical lesions; and (4) the bladder epithelium continues to be stimulated by intra-urinary carcinogenic substances. If correct bladder irrigation treatment is used, its recurrence rate can be reduced by half, generally to about 30%. Regular postoperative bladder irrigation chemotherapy can effectively prevent tumor recurrence and inhibit tumor progression to infiltration, and it is simple to operate and has few adverse effects, which is an important part of the treatment of non-primary invasive bladder uroepithelial carcinoma. 3.Commonly used drugs for postoperative perfusion chemotherapy for bladder cancer? The ideal bladder perfusion chemotherapy should be a drug that can rapidly reach the concentration of effective drugs in the bladder epithelium with little systemic absorption and low toxic side effects. Current bladder cancer perfusion drugs are divided into two categories; their common doses, solvents, concentrations, and retention times are shown in the table. According to the published literature, it is not yet possible to evaluate which chemical drug perfusion has better efficacy. (1) Chemotherapeutic agents: epirubicin (weights and weights, et al.), pirarubicin (THP, etc.), mitomycin, hydroxycamptothecin, gemcitabine (Zephyr, etc.), doxorubicin, etc. (2) Biologic agents: including BCG, interferon 4. Cycle of bladder perfusion chemotherapy For intermediate-risk non-muscle invasive cystectomy with immediate 24-hour bladder perfusion in addition to immediate bladder perfusion, subsequent early bladder perfusion once a week for 4-8 weeks in the 1st-2nd months after surgery, and once a month for 6-12 times in the 3rd-12th months after surgery. For low-risk patients with non-muscle invasive bladder cancer, after completion of immediate perfusion chemotherapy within 24 hours after surgery, subsequent bladder perfusion therapy can be discontinued. 5. Perfusion procedure (1) The patient lies flat on the treatment bed with a waterproof mat. (2) The therapist washes hands and wears professional protection and sterile gloves. (3) Disinfect around the patient’s perineum for 2 times. (4) Place the urinary catheter under aseptic operation to fully drain the urine from the bladder. (5) The drug is slowly injected into the bladder. If the patient has pain during drug instillation, stop the instillation immediately and continue pushing after improvement, if still not tolerated, stop this instillation treatment. (6) The urethra can be removed immediately after the drug is instilled into the bladder or still retained. (7) Ask the patient to change the position appropriately and intermittently during the period of drug retention in the bladder if the condition allows. 6.What are the main adverse effects of bladder perfusion chemotherapy? Bladder irrigation can kill some relatively small or potential tumors in the bladder; since the drug only comes into contact with the bladder lining and does not enter the bloodstream, it does not cause side effects such as vomiting, hair loss, white blood cell drop and liver and kidney damage, which are common with intravenous chemotherapy. About 10-25% of patients experience adverse reactions during bladder perfusion. Urinary frequency and urgency Drugs stimulate the submucosal nerves of the bladder, causing increased bladder sensitivity and frequent and urgent urination. Do good psychological care for patients, relieve tension, encourage more water and urination, and continue perfusion treatment after symptoms are significantly reduced, or extend the interval between perfusions. 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 occurs mostly 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 the urethral mucosa. A thin and soft urethral catheter, strict aseptic operation and adequate lubrication of the urethral catheter should be used to reduce the occurrence of urethral stricture. 7.Cautions for bladder infusion chemotherapy It is not necessary to fast, abstain from water 2 hours before infusion of drugs, and urinate before treatment to avoid dilution of drugs by residual urine in the bladder, which may reduce the therapeutic effect. Stay relaxed when inserting the catheter and removing it, tension will aggravate the damage to the urethra; for patients with urethral stricture, prostatic hyperplasia, etc., explain to the outpatient doctor in advance so that the appropriate size catheter can be replaced. Drink more water within 24h after the end of perfusion to increase the volume of urine, to excrete residual drugs and prevent urethral infection. Eat a reasonable diet and avoid stimulating foods. Avoid tea, coffee, alcohol, and cola-based beverages during this period to reduce bladder irritation. Bladder irrigation should be postponed for fever and infection; irrigation may cause internal bladder congestion and redness, which may affect observation, and cystoscopy should be performed after two weeks of bladder irrigation. On time, completing the entire course of irrigation according to the course of treatment is essential to reduce recurrence; regular follow-up, even if adverse effects are detected and treated appropriately. Treatment after drug contamination or staining: Once the drug stains the skin, local irrigation is required. For mitomycin staining, use sodium bicarbonate (baking soda) solution (8.4%) to rinse; for other drug staining, use plenty of soapy water to rinse, and then rinse with water. After cleaning the drug-stained skin, do not use hand cream or emollient topical application, otherwise it may increase the absorption of drugs. If the drug stains the eyes or mucous membranes, it should be flushed with plenty of saline. For other forms of spills, cover the spill with an absorbent cloth and dispose of it in a special medical waste bag. The spill area should be flushed with plenty of soapy water. (2) Eat more vegetables and fruits, especially cabbage, cauliflower, radish, cabbage, rape, capers and fresh fruits such as peaches, bananas and dates; (3) Eat less fatty foods, the more fatty foods you eat, the greater the risk of bladder cancer; (4) Eat more foods rich in vitamin A and carrots, which can reduce the risk of bladder cancer. can reduce the risk of bladder cancer. (1) Avoid moldy, greasy and fatty foods; (2) Avoid smoking, alcohol, coffee and cocoa; (3) Avoid spicy and hot foods that move blood.