Reduced recurrence of low-grade papillary bladder tumors associated with asymptomatic bacteriuria Journal Article


Authors: Herr, H.; Donat, M.
Article Title: Reduced recurrence of low-grade papillary bladder tumors associated with asymptomatic bacteriuria
Abstract: Objective: To determine tumor recurrence rate of low-grade, papillary, and non–muscle-invasive (TaLG) bladder tumors in patients who have asymptomatic bacteriuria (ABU). Microbes in the urine trigger immune responses like intravesical Bacillus Calmette-Guerin, suggesting that common bacteria may also exert an antitumor effect. Methods: We investigated recurrence rates in 387 patients with low-grade, papillary noninvasive bladder tumors TaLG, with or without ABU. They were followed every 6 months for 36 months, and did not receive antibiotics or intravesical chemotherapy. Recurrent tumors were treated generally by outpatient fulguration. Before cystoscopy, patients submitted a voided urine sample for culture, stratified as no growth, <10 4 , >10 4 , or >10 5 CFU/mL single organism. Any degree of bacteria on culture was classified as ABU. We also measured absolute neutrophil counts (ANC) and the presence of pyuria, as surrogate indicators of local immune response. Results: Of the 387 cases, 200 (52%) had ABU, including 102 (27%) with >10 4 CFU/mL bacteriuria. With absolute 3-year follow-up, 75% of patients with ABU survived tumor-free compared to 40% of 187 uninfected patients (P =.001). Sixty percent of patients with negative cultures recurred vs 25%, 14%, and 29% of patients with <10 4 , >10 4 , or >10 5 CFU/mL. (P =.001). Mean number of recurrent tumors in colonized patients was 4.2 vs 8.4 in uninfected patients (P =.009). ANC averaged 6.3 K/mcL in bacteriuric vs 4.1 K/mcL in uninfected patients (P =.01). Conclusion: Patients with papillary TaLG tumors and chronic ABU had fewer recurrences, fewer numbers of recurrent tumors, and longer tumor-free survival times than similarly staged uninfected patients. Bladder-resident bacteria may reduce bladder tumor recurrences through local immune mechanisms. © 2018
Keywords: adult; aged; major clinical study; cancer recurrence; follow up; cancer grading; disease association; neutrophil count; retrospective study; bladder tumor; outpatient; cystoscopy; papilloma; bacterium culture; correlational study; asymptomatic bacteriuria; cauterization; pyuria; human; male; female; priority journal; article; urine sampling
Journal Title: Urology
Volume: 124
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2019-02-01
Start Page: 179
End Page: 182
Language: English
DOI: 10.1016/j.urology.2018.10.023
PUBMED: 30359714
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Sherri M Donat
    135 Donat
  2. Harry W Herr
    407 Herr