A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer.

BACKGROUND: Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. OBJECTIVE: To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. METHOD: A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. RESULTS: The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. CONCLUSIONS: The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.

Conductive hyperthermic chemotherapy versus electromotive drug administration of mitomycin C as intravesical adjuvant treatment of patients with intermediate or high-risk non-muscle invasive bladder cancer.

BACKGROUND: Devices that increase the penetration of intravesical chemotherapeutic agents have been developed as alternatives to the use of bacillus Calmette-Guérin, in short supply at a time of increasing global incidence of non-muscle invasive bladder cancer (NMIBC). We performed a prospective observational study to compare 2 of these devices in the treatment of patients with high- and intermediate-risk NMIBC. The primary endpoint was the recurrence-free rate. Secondary endpoints were the rate of progression and adverse events. METHODS: After undergoing transurethral bladder resection, 98 patients were selected to receive 1 of 2 treatments: hyperthermic intravesical chemotherapy (HIVEC) treatment with 40 mg of mitomycin C (MMC) using Combat BRS System V2.0 at 43 ± 0.5°C and 200 ml/min for 60 minutes (56 patients) or electromotive drug administration (EMDA) with 40 mg of MMC at 20 mA for 30 minutes (42 patients). The treatment schemes were similar: 6 weekly instillations as induction and 6-monthly instillations as maintenance. The recurrence rates were evaluated at 6 and 12 months and the progression rates at 12 months. RESULTS: The recurrence-free rate at 12 months was 91,1% in the HIVEC group and 88.1% in the EMDA group (P ≥ 0.05). After the 12-month follow-up, only 1 progression occurred in each treatment group. In terms of adverse events, no significant differences were found between the treatments. CONCLUSIONS: HIVEC and EMDA techniques are comparable in terms of recurrence, progression and adverse events at 12 months in the treatment of patients with high- and intermediate-risk NMIBC.

Comprehensive prediction model of urinary incontinence one year following robot-assisted radical prostatectomy.

OBJECTIVES: Urinary incontinence (UI) still remains one of the major functional complications after robot-assisted radical prostatectomy (RARP). As the cause for UI is multifactorial, it is quite difficult to make a prediction preoperatively. Considering intraoperative and postoperative risk factors, besides the preoperative ones, we designed an incontinence prediction model, administered 1 month after the surgery, in order to identify incontinent patients at 1 year. PATIENTS AND METHODS: We retrospectively reviewed 244 patients who underwent RARP at our institution. Only 209 patients had sufficient data, a 1-year follow-up and were continent preoperatively. The association of UI with the risk factors was assessed by univariable and multivariable regression models. RESULTS: There was a 17.2% global UI rate at 1 year after RARP. Only age-adjusted Charlson comorbidity index, erectile function assessed by International Index of Erectile Function-5, prostate volume, nerve-sparing status and 24-hour urine loss at 1 month correlated with UI (p = 0.032, 0.009, 0.031, 0.018 and <0.001, respectively). The accuracy of the prediction model of UI was 92.8% (c-index), with an area under the curve of 91.9%. CONCLUSION: Age-adjusted Charlson comorbidity index, International Index of Erectile Function-5, prostate volume, nerve-sparing status and 24-hour urine loss at 1 month after RARP can predict an individual's risk of UI at 1 year after RARP with good accuracy. Further external validation is required in order to generalize the use of this model.