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. 2017 Apr 27;3(2):133-138.
doi: 10.3233/BLC-160089.

A Management Algorithm for Mitomycin C Induced Cystitis

Amy N Luckenbaugh  1 , Rory M Marks  2 , David C Miller  1 , Alon Z Weizer  1 , John T Stoffel  1 , Jeffrey S Montgomery  1
Affiliations
Free PMC article

A Management Algorithm for Mitomycin C Induced Cystitis

Amy N Luckenbaugh et al. Bladder Cancer. .
Free PMC article

Abstract

Background/Objective: A post-bladder tumor resection dose of MMC can reduce non-invasive papillary (pTa) bladder cancer recurrences by up to 40%; this treatment is recommended in both the AUA and EUA non-muscle-invasive bladder cancer guidelines. A common complication of this treatment is eosinophilic cystitis. Symptoms range from mild urinary frequency and urgency to debilitating pain and dysuria. Currently, there is no established treatment algorithm for MMC-induced cystitis. Methods: Members of the Urologic Surgery Quality Collaborative (USQC), a group composed of over 160 private and academic urologists, met to discuss the management of patients with cystitis following MMC therapy. They devised a treatment algorithm based on experiences of urologic oncologists and neurourologists to aid in the diagnosis and management of MMC-induced cystitis. Results: The assessment begins with urinalysis and culture, followed by cystoscopy. For mild symptoms, behavioral therapy, including timed voids, fluid restriction and Kegel exercises are trialed. If symptoms have not resolved, treatment with an antihistamine, followed by a combination of anticholinergic and alpha-blocker medications. For persistent symptoms or severe symptoms at presentation, a course of prednisone plus antihistamine is prescribed. If symptoms are improving but have not resolved, this treatment is extended for a full 4 weeks prior to steroid taper. If symptoms do not improve, any visible bladder ulcerations are resected intraoperatively followed by an additional course of prednisone and antihistamine. Intravesical DMSO instillations and intra-ulcer steroid injection can be used as a final effort to treat this condition. Conclusion: We present the first formal management algorithm with escalating treatment intensity tailored to patient symptoms.

Keywords: Urinary bladder neoplasms; mitomycin C.

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Figures

Fig.1
Fig.1
Mitomycin-C treatment algorithm demonstrating the escalation of therapy for management of symptoms. Depending on the severity of the patient’s symptoms steps in the algorithm may be skipped.
Fig.2
Fig.2
CT scan of MMC cystitis: pre-algorithm treatment image demonstrates bladder wall thickening suggestive of bladder cancer recurrence; however, this was biopsy proven MMC cystitis. The post-treatment image on the bottom was following steroids and antihistamine treatment per algorithm.
Fig.3
Fig.3
Cystoscopic images: Mitomycin-C induced cystitis pre- and post-treatment (top and bottom respectively) utilizing the algorithm.
Fig.4
Fig.4
Bladder biopsy of Mitomycin-C cystitis. Biopsy demonstrates numerous eosinophils consistent with MMC induced cystitis.
See this image and copyright information in PMC

References

    1. Doll DC, Weiss RB, Issell BF. Mitomycin: Ten years after approval for marketing. J Clin Oncol 1985;3(2):276–86. - PubMed
    1. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Comperat E, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: Update 2013. Eur Urol 2013;64(4):639–53. - PubMed
    1. Hall MC, Chang SS, Dalbagni G, Pruthi RS, Seigne JD, Skinner EC, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol 2007;178(6):2314–30. - PubMed
    1. Sylvester RJ, Oosterlinck W, van der Meijden AP. A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: A meta-analysis of published results of randomized clinical trials. J Urol 2004;171(6 Pt 1):2186–90, quiz 435. - PubMed
    1. Solsona E, Iborra I, Ricos JV, Monros JL, Casanova J, Dumont R. Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer: Short and long-term followup. J Urol 1999;161(4):1120–3. - PubMed

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