Efficacy of transurethral submucosal dissection of bladder tumor combined with intraoperative bladder submucosal injection of gemcitabine in treatment of non-muscle invasive urothelial bladder cancer: a report of seven cases

Abstract:

Objective To investigate the safety and efficacy of transurethral submucosal dissection of bladder tumor combined with intraoperative bladder submucosal injection of gemcitabine in the treatment of non-muscle invasive urothelial bladder cancer（NMIBC）.Methods A retrospective analysis was performed for the clinical data of seven patients with solitary NMIBC who were admitted to our department from June 2021 to September 2022. Bladder tumor-endoscopic submucosal dissection（BT-ESD） was performed after the formation of local edema by injection of gemcitabine（20 mg/mL） at the base of the tumor via cystoscopy using a special bladder mucosal injection needle. Time of operation，length of postoperative hospital stay，postoperative pathological findings，and postoperative complications were recorded，and intraoperative blood loss was estimated. Cystoscopy was performed at 3 months and 1 year after surgery，and recurrence rate was calculated.Results All seven patients underwent successful BT-ESD，with no patients converted to open surgery or other surgical regimens. There was no unscheduled postoperative reoperation for hemostasis，traumatic bladder perforation or intraoperative blood transfusion. Of all seven patients，there were five male patients and two female patients，and the maximum tumor diameter ranged from 0.7 to 2.0 cm，with a mean diameter of （0.9±0.4） cm；all tumors were cauliflower-shaped and pedicled and were located in the lateral wall of the bladder in two patients，in the right ureteral ridge in two patients，in the left ureteral ridge in two patients，and in the trigone in one patient. The time of operation was 20-40 minutes，with a mean time of （31.40±2.67） minutes. The volume of intraoperative blood loss was 1-5 mL，with a mean volume of （2.24±1.46） mL. The length of postoperative hospital stay was 1-2 days. Postoperative pathological findings showed low-risk NMIBC with negative surgical margins. Cystoscopy was performed at 3 months and 1 year after surgery and showed no recurrence or progression.Conclusion The submucosal injection of gemcitabine into the bladder during BT-ESD is safe，reliable，and effective in the treatment of NMICB.