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How to reduce bacillus Calmette-Guérin discontinuation in patients with severe functional impairment
- Source :
- Current Urology, Vol 16, Iss 3, Pp 160-167 (2022)
- Publication Year :
- 2022
- Publisher :
- Wolters Kluwer Health, 2022.
-
Abstract
- Abstract. Background. Severe functional impairment is often considered a contraindication to intravesical therapy for nonmuscle-invasive bladder cancer (NMIBC). A tailored intravesical bacillus Calmette-Guérin (BCG) procedure was evaluated in high-risk (HR)-NMIBC patients with severe functional impairment. Materials and methods. Patients with a Katz Index score of 2 or less and an initial diagnosis of HR-NMIBC with atraumatic insertion of a Foley-type indwelling catheter, bladder emptying, and BCG instillation were prospectively treated; after 2 hours, the bladder was emptied and the catheter was removed (group A). After propensity score matching, 52 patients in group A were compared with that of 52 consecutive patients in group B using a retrospective database, with similar baseline/oncological characteristics and treated with standard intermittent catheterization. Moreover, groups A and B were compared with that of 130 consecutive patients (group C) retrospectively evaluated, with similar oncological characteristics but with a Katz Index score of 3 or greater and treated with standard intermittent catheterization. Results. The discontinuation rates were 11.5%, 35%, and 9% in groups A, B, and C, respectively (A vs. B, log-rank score 42.52 [p < 0.05]; B vs. C, 107.6 [p < 0.05]; A vs. C, 3.45 [p > 0.05]). The overall adverse event rates were 38.5%, 57.7%, and 39.2%, respectively (A vs. B, p = 0.04; B vs. C, 0.03; A vs. C, 0.92). The rates of severe adverse events were 1.9%, 1.9%, and 1.5%, respectively, without statistically significant differences. The cumulative HR disease-free survival rates were 63.4%, 48%, and 69.2%, respectively (A vs. B, log-rank score 154.9 [p < 0.05]; B vs. C, 415 [p < 0.05]; A vs. C, 244 [p < 0.05]). Conclusions. A tailored intravesical instillation procedure may reduce BCG discontinuation and adverse effects.
- Subjects :
- Diseases of the genitourinary system. Urology
RC870-923
Subjects
Details
- Language :
- English
- ISSN :
- 16617649 and 00000000
- Volume :
- 16
- Issue :
- 3
- Database :
- Directory of Open Access Journals
- Journal :
- Current Urology
- Publication Type :
- Academic Journal
- Accession number :
- edsdoj.0e1db2e879d841cba6513bdc57a66f78
- Document Type :
- article
- Full Text :
- https://doi.org/10.1097/CU9.0000000000000134