Intravesical mitomycin C efficacy in acidic and alkaline urinary pH: impact on recurrence-free survival rate after TURBT

Abstract

Background: Urinary bladder tumor recurrence following transurethral resection of bladder tumor (TURBT) is a common issue. This study aims to determine how urine alkalinization affects bladder tumor recurrence after surgery. Materials and methods: Sixty patients receiving mitomycin C (MMC) therapy after TURBT were divided into two groups based on mean pH values. Twenty-six patients were in group A, whose urine pH was below 5.5. However, there were 34 patients in group B, and their urine pH was higher than 5.5. Both groups of patients were given intravesical MMC once weekly for 6 weeks following TURBT. A cystoscopy was performed as a follow-up at 3, 6, and 12 months. Urine pH and the recurrence-free survival rate were compared using Kaplan–Meier survival analysis and the COX proportional hazard model. Results: The mean time to tumor recurrence in group A (intravesical MMC in acidic urine) and group B (intravesical MMC in alkaline urine) was 12.48 versus 16.84 months, respectively. Alkaline urine pH was identified as an independent predictor of preventing the recurrence of superficial bladder tumors by univariate COX regression analysis. Age, sex, and mean tumor size did not affect the likelihood of tumor recurrence. However, smoking had an association with increased tumor recurrence. Conclusion: Tumor recurrence post-TURBT is delayed in patients with alkaline urine pH. Smoking is an independent risk factor for bladder tumors.