Relationship between Preoperative Pyuria and Bacille Calmette-Guerin Treatment in Intravesical Recurrence after Transurethral Resection of High-Risk, Non-Muscle Invasive, Bladder Carcinoma: A Retrospective Study of Human Data

SIMPLE SUMMARY: Some researchers have found that preoperative pyuria is a risk factor for the recurrence of high-risk non-muscle invasive bladder cancer. However, no one has determined the risks of pyuria in relation to bacille Calmette-Guerin (BCG) treatment status. We defined pyuria as ≥10 white blood cells per high-power field. We analyzed recurrence-free rates in 424 patients with high-risk non-muscle invasive bladder cancer who had and had not undergone BCG treatment. We identified no risk factors for recurrence in the BCG-treated group (n = 179). However, in the non-BCG treated group (n = 245), pyuria was associated with being female and having T1 cancer. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. No significant difference in the severity of pyuria was found between BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk non-muscle invasive bladder cancer and pyuria. ABSTRACT: Some researchers have found that preoperative pyuria is a risk factor for recurrence after transurethral resection of high-risk non-muscle invasive bladder cancer. However, to our knowledge, none have clarified the risks associated with pyuria according to bacille Calmette-Guerin (BCG) treatment status. We retrospectively selected patients with high-risk non-muscle invasive bladder cancer according to Japanese Urological Association guidelines. Pyuria was defined as ≥10 white blood cells per high-powered field. We analyzed recurrence-free rates (RFS) in 424 patients who had and had not undergone BCG treatment. The median duration of follow-up was 45.2 months. According to multivariate analysis, postoperative intravesical BCG induction and preoperative pyuria were independent risk factors for intravesical recurrence in the whole study cohort. We found no significant risk factors for recurrence in the BCG-treated group (n = 179). In the non-BCG-treated group (n = 245), patients with pyuria were much more frequently female and more often had T1 disease than patients without pyuria. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. There was no significant difference in the severity of pyuria between the BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk NMIBC and pyuria.