Administering mitomycin C, in theatre, immediately after transurethral bladder cancer resection (TURBT) is the "earliest and surest" prophylaxis against tumor cell re-implantation, say UK clinicians.

A meta-analysis of seven randomized, controlled trials recently confirmed that intravesical chemotherapy given within 24 hours of TURBT typically reduces recurrence risk by 39%.

But A Mostafid and associates from North Hampshire Hospital in Basingstoke, argue that, for maximum benefit, intravesical chemotherapy should be given with 6 hours of surgery.

However, "this policy does not seem to have been universally adopted, partly because the co-ordination of timely administration can often be difficult," they write in the journal BJU International.

To get around this problem, Mostafid and team used a closed, user-friendly delivery device to reconstitute and deliver mitomycin C in 177 patients immediately after they had undergone TURBT.

The authors report that, in one patient, the catheter balloon spontaneously deflated in the recovery ward, causing the catheter to fall out and leak mitomycin C onto the patient's skin.

Another patient complained of suprapubic pain after surgery, which the researchers attributed to extravasation of mitomycin C. This symptom disappeared after the mitomycin C solution was drained from the bladder.

The scientists summarize: "The immediate instillation of mitomycin C after TURBT is a feasible and safe method of administering intravesical chemotherapy, and may provide the earliest and most effective prophylaxis against tumor cell re-implantation at TURBT."

They add: "The technique has additional practical and financial benefits by eliminating the need for ward-based chemotherapy instillation and bladder irrigation."

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