Perioperative instillation therapy in superficial bladder cancer: is it effective regarding outcome and costs?
OBJECTIVE
This article reviews the current knowledge concerning immediate intravesical instillation therapy in nonmuscle-invasive bladder cancer after transurethral resection of the bladder tumour, with emphasis on the literature of the last few years.


RESULTS
A review was conducted on the recent literature available by PubMed database on the subject of immediate bladder chemotherapy after transurethral resection of the bladder tumour and its recent developments.


CONCLUSIONS
A single immediate bladder instillation with chemotherapy will give 39% reduction of recurrence. Numbers needed to treat to prevent one recurrence are estimated at 8.5. In intermediate and high-risk bladder cancer, the immediate postoperative instillation does not give sufficient reduction in recurrence rate to leave out subsequent bladder instillations. The significant reduction of recurrences, the mild side-effects of the treatment and the clear cost-effectiveness make one immediate instillation a valuable addition to transurethral resection of the bladder tumour in the treatment of nonmuscle-invasive bladder cancer. Points of controversy are the true numbers needed to treat to prevent a recurrence and the type of recurrences that will be prevented. No new types of instillation are added recently to the ones available, but promising types are under investigation of which pharmacokinetic studies have shown acceptable rates of side-effects.
Engel
Roel Peter
RP
Department of Urology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Witjes
J Alfred
JA
D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000601:surgery
D000970:Antineoplastic Agents