This week, we’ll start with the drug and the course of treatment, and next week, I’ll introduce some precautions during the course of perfusion therapy. When it comes to drug therapy, what I want my patients to know most is the concept of clinical drug trials. We often say that medicine is an empirical science, but at the extreme, it is an outcome-oriented science, which is especially evident in drug therapy, where a drug can be used if it works for most patients, regardless of the mechanism by which it achieves its effect. Many drugs are even used in the clinic first, and then their mechanisms are studied. The majority is the statistically calculated “majority,” and effective means achieving the goal the doctor wants, which can be a cure, longer life, fewer relapses, or symptom relief. The process of calculating the statistical efficiency is what we call a drug clinical trial. Cao Ming, Department of Urology, Shanghai Renji Hospital Therefore, it can be said that the drug treatment protocols that we are now using including the bladder irrigation treatment protocol that I will talk about next are determined by the results of thousands of previous cases treated, and these protocols are good for most patients, but not for all. I will then introduce you to some of the concepts of bladder irrigation therapy, in the order that the most meaningful is the one with the highest “efficiency” and then the one with the lowest. The first concept is that the first postoperative infusion of chemotherapy should be done within 24 hours after minimally invasive surgery, which is called immediate infusion. This first infusion has the strongest effect on reducing bladder tumor recurrence in the future. However, since some patients may not have a clear pathology at the time of surgery, if the tumor is considered benign, then irrigation is not necessary. In addition, if the tumor is deep and the bladder wall is deeply cut and may be perforated, this should never be perfused; in addition, if the tumor involves the ureteral opening, surgical removal of the ureteral opening should also be considered for perfusion. The second concept is that the duration of chemotherapy infusion is definitely not the longer the better, but generally the longest duration is one year. From the current clinical trial data, the use of chemotherapy drug perfusion, perfusion two years three years in addition to a little increase in the complications of perfusion does not increase the effect of perfusion, even in patients at high risk of recurrence generally in the perfusion to 6 to 12 months after the continuation of treatment will not reduce its recurrence rate. Therefore, the maximum duration of chemotherapy infusion is set to 12 months in the treatment protocols for bladder tumors in various countries, and even one infusion or 2 months is enough for some patients with low or intermediate risk of recurrence. You can listen to your physician’s advice in the clinic and stop the medication after a certain period of time. You don’t have to wonder why some patients are still being treated and the doctors let you stop the medication so early, in fact, it just means that your condition is relatively mild and it is definitely a cause for celebration to stop the medication. The third thing is the choice of drugs, this thing actually to explain is that there are two kinds of bladder tumor perfusion, one is chemotherapy, the other is immunotherapy, that is, BCG vaccine, BCG vaccine is for refractory patients or serious patients, at present the domestic because BCG vaccine just listed, buy drug pathways and drug costs are limited BCG vaccine is widely used. The vast majority of patients use the same chemotherapy that I talked about earlier for one year of infusion, but there are many chemotherapy drugs that can be used, including epirubicin, piribicin, mitomycin, gemcitabine, etc. In fact ~~~~~, from the clinical trial data, the total efficiency of these drugs is basically the same, so there is not much significance in the choice of drugs at the beginning, but if there are frequent relapses during the treatment process, I Personally, I suggest to consider switching to other drugs to try, because the total efficiency of each drug is basically the same, but the specific patients for which it is effective or different. This drug has been used for bladder tumor perfusion therapy for a long time, and currently, BCG is the first choice of treatment for high-risk patients in all national guidelines. Therefore, BCG is a more effective treatment than common chemotherapy drugs, but it is not suitable for low and intermediate risk patients, because first of all, the side effects of BCG treatment are much stronger than common chemotherapy drugs, which may cause strong urinary frequency and urgency and even high fever, and may cause serious bladder capacity reduction. However, in high-risk patients, the efficacy of BCG vaccine is recognized worldwide. The current BCG infusion regimen is designed to last two to three years, usually starting two weeks after surgery, with the first phase being once a week for six consecutive weeks for the induction period, followed by the maintenance phase, with one round of treatment every three months, and the treatment being once a week for three consecutive weeks, with such a round repeated every three months. About perfusion, today we will talk about these four points first, and we can mention what we did not talk about. We will continue next week.