| ObjectiveTo investigate the effects of different bladder irrigation fluids and time on the residual time and complications of bladder cancer after electrosurgical resection of bladder cancer.Date and MethodsFrom 2018-06-01 to 2019-03-01,60 bladder cancer patients who are confirmed by cystoscopy and biopsy in urology department of Shandong Provincial Hospital were enrolled in the study.Our study was a randomized controlled single-blind trials.The patients who were enrolled in our study group were not acknowledged to the detailed group of our investigation and all of they have signed informed consent.In this study,all patients were divided into four groups:experimental group A1:patients are irrigated with 3000ml distilled water immediately after TURBT and then irrigated with normal saline for 2 days;experimental group A2:patients are irrigated with 3000ml distilled water immediately after TURBT and then irrigated with normal saline for 4 days;Control group B1:patients were irrigated with normal saline for 2 days immediately after TURBT operation.Control group B2:patients were irrigated with normal saline for 4 days immediately after TURBT operation.100 ml urine or bladder irrigation fluid was collected from all patients on the first day before operation,immediately after operation,the first day after operation,the second day after operation,and the fourth day after operation.Urinary exfoliation cytology,bladder cancer cell count,white blood cell count were performed and the incidence of infection and bleeding after TURBT operation was counted.ResultsThere was no significant difference in the basic information including age and sex among all the 60 patients in A1,A2,B1 and B2 groups.The average age of the patients was 61.0±8.2 years old.The result of variance analysis of ages was P = 0.622.There was no statistical significance.The ratio of male to female was 46:14 in the patients.Chi-square analysis showed that P = 0.601 which have no statistically significant in each group.The average size of tumors in Al,A2,B1 and B2 groups were 2.5±0.7cm,2.0±0.6cm,2.3±0.8cm and 2.3±0.8cm,respectively.Multiplex t-test showed that P=0.102.The ratio of single to multiple tumors in each group was 10/5,7/8,11/4 and 8/7 respectively.Chi-square test was performed,which result is that P=0.427.All the participants in this study were classified to 2 types(Ta or others)according to the tumor stages and the result is that that there were 10/5 in group Al,7/8 in group A2,11/4 in group B1 and 8/7 in group B2.There was no significant difference in the classification(P=0.427).One patient in group A1 and group B1 underwent TURP simultaneously.The positive rate of bladder tumors of urine cytology before operation was 3/15 in group Al,5/15 in group A2,2/15 in group B1 and 3/15 in group B2.FISH exact test showed that there was no statistical difference among the groups.The FISH exact examination was performed on the patient who are irrigated for 2 days or 4 days about the positive rate of bladder tumors of urine cytology,P>0.05.There was no significant difference in the positive rate of bladder cancer cells in urinary exfoliation cytology between groups.The average number of exfoliated leukocytes in urine of Al group was 12.5±9.1,A2 group was 13.4±7.7,B1 group was 13.0±5.4 and B2 group was 15.3±7.3.There was no significant difference between the two groups.Urinary exfoliated cytology of patients which was collected immediately after operation showed that the positive rate of bladder cancer cells in each group was high.,which was in A1 group:14/15,A2 group:13/15,B1 group:14/15,B2 group:14/15,P=0.884,respectively.On the first day after operation,the urinary exfoliated cytology showed that the positive rate of tumor cells in test group was significantly lower than that in control group,A1 group:4/15,A2 group:3/15,B1 group:8/15,B2 group:9/15.Chi-square test showed that P<0.05,which has statistical significance.On the 2nd and 4th day after operation,urinary exfoliated cells were examined again,which show that P>0.05 between the four groups,meaning no statistical significance.After TURBT,the urinary exfoliated cytology couints showed that the average white blood cell content in bladder irrigation fluid was 19.4±7.8.There was no significant difference in the white blood cell content among each groups.Statistical analysis showed that the white blood cell count in urine was significantly higher than that before TURBT(P<0.001).On mmediate postoperative,the 1st,2nd and 4th day after operation,the average leucocyte content in urine exfoliated cytology was 19.4±7.8?15.2±4.2?10.0±3.8?5.6±4.0.The analysis of variance P<0.001 had statistical significance and the leucocyte content decreased with the increase of irrigating time.All of the 60 patients enrolled in this study,only one patient in the experimental group had postoperative bleeding,and only one patient underwent TURP operation at the same time.The irrigation fluid was still very red 1d after TURBT.The patient was advised to take the lateral position.After 4 hours of flexion and clamping of the legs,the irrigation fluid became clear.Each of group A1,B1 and B2 had one patient who gotfever after operation,and the highest body temperature was above 38.0?.The patients were treated with levofloxacin and improved after symptomatic treatment.Conclusions1.patients who are treated with 3000mL distilled water bladder irrigation before continuous bladder irrigation with normal saline can reduce the residual time of bladder tumors.2.There was no significant difference in residual bladder cancer cells between patients who are irrigated with normal saline for 2 or 4 days after bladder irrigation.Extending bladder irrigation time to 4 days after bladder cancer surgery could not reduce the risk of recurrence of bladder cancer.3.With the prolongation of bladder irrigation time,the amount of white blood cells in bladder can decrease.Although the amount of white blood cells in bladder decreases with the prolongation of bladder irrigation time,this study has not proved that it can reduce the probability of postoperative infection.4.Irrigation of bladder with 3000ml distilled water immediately after TURBT does not increase the risk of bleeding. |
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