Treatment-Related Cystitis During Intravesical Chemotherapy: Incidence, Risk Factors, And Nursing-Pathway Associations

Summary

Treatment-related cystitis is common during intravesical chemotherapy and may compromise treatment completion. This retrospective single-center cohort quantified cystitis incidence, identified associated clinical and procedural factors, and examined whether a preventive nursing pathway was associated with lower cystitis burden and fewer treatment interruptions.

Abstract

Intravesical chemotherapy is routinely used after transurethral resection of bladder tumors for non-muscle-invasive bladder cancer, but treatment-related cystitis (TRC) may disrupt planned care. This retrospective, single-center, observational cohort study quantified TRC incidence, identified associated clinical and procedural factors, and examined the association between a preventive nursing pathway and TRC-related outcomes. We analyzed 120 consecutive patients receiving intravesical chemotherapy and compared patients managed under standard care (n = 60) with those managed under a preventive nursing pathway (n = 60) according to routine clinical pathway assignment. TRC was assessed within 7 days after each documented instillation, and interruption-free completion was evaluated during the documented intravesical treatment course. TRC events were captured from electronic medical records using predefined symptom documentation and follow-up records. Risk factors were evaluated using multivariable regression, and time to event analysis was used to assess treatment interruption attributable to TRC. TRC occurred in 45.8% of patients. A shorter interval from transurethral resection to first instillation (OR = 0.83 per 7-day increase), multiple catheterization attempts (OR = 1.41), and higher baseline symptom burden were associated with increased TRC risk. After adjustment, management under the preventive nursing pathway was associated with lower odds of TRC (aOR = 0.54, 95% CI: 0.29–0.98; P = 0.043). As this study was non-randomized and based on routine care pathway assignment, these findings should be interpreted as adjusted associations rather than evidence of a causal intervention effect. The findings suggest that TRC is a substantial real-world burden during intravesical chemotherapy and that structured nursing documentation, baseline assessment, catheterization quality control, symptom monitoring, and early escalation may support risk-stratified follow-up. As no direct mucosal or biomarker measurements were obtained, urothelial barrier injury is discussed as a plausible mechanism rather than a demonstrated effect.

Introduction

Non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease with a high recurrence rate, and postoperative management therefore focuses on reducing recurrence while limiting progression to muscle-invasive disease^1,2. Transurethral resection of bladder tumors (TURBT) followed by intravesical treatment remains a central strategy in postoperative management. Intravesical management includes chemotherapy agents, such as gemcitabine, mitomycin C, and pirarubicin, as well as immunotherapeutic approaches such as Bacillus Calmette-Guérin (BCG)^3,4

Protocol

The study was approved by the Ethics Committee of the Second Affiliated Hospital of Wenzhou Medical University (approval number: B2025461X; approval date: January 10, 2025). The requirement for individual informed consent was waived because the study used retrospectively collected routine-care records and involved no direct patient contact or change to clinical management. All patient identifiers, including names, medical record numbers, telephone numbers, and addresses, were removed before analysis. The de-identified dataset was stored in password-protected files accessible only to authorized study personnel.

Study design and data ....

Results

Cohort characteristics and documented uptake of the preventive nursing pathway

A total of 120 patients receiving intravesical chemotherapy were included, with 60 patients in the standard-care group and 60 patients in the preventive nursing-pathway group. The cohort was predominantly male (81.7%) and middle-aged to older. Baseline demographic and clinical characteristics were generally comparable between groups (Table 1). The median interval from TURBT to first.......

Discussion

This retrospective single-center cohort study found that treatment-related cystitis (TRC) was frequently documented among patients receiving intravesical chemotherapy. Nearly half of the cohort experienced at least one TRC episode, and more than one-fifth developed grade ≥2 TRC. These findings are consistent with previous reports showing that intravesical treatment can be accompanied by clinically relevant urinary toxicity and treatment-related discomfort³⁰. In the present cohort, TRC was no.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Disposable sterile urinary catheter, 12–16 Fr	Well Lead Medical Co., Ltd.	Manufacturer product information page: Wellead urology catheter / all silicone Foley catheter	Used for intravesical catheterization and bladder instillation procedures
Electronic medical record system	Second Affiliated Hospital of Wenzhou Medical University	Not applicable; institutional electronic medical record system	Source of demographic data, diagnosis, comorbidities, treatment records, clinical notes, and follow-up documentation
Epirubicin hydrochloride for injection	Pfizer or hospital-procured equivalent manufacturer	Manufacturer prescribing information or institutional pharmacy procurement record	Intravesical chemotherapy agent recorded in chemotherapy orders
Follow-up documentation records	Second Affiliated Hospital of Wenzhou Medical University	Not applicable; institutional outpatient, telephone, and nursing follow-up records	Source of 24–72 h follow-up completion, post-instillation symptoms, care escalation, and treatment-interruption documentation
Gemcitabine for injection	Jiangsu Hansoh Pharmaceutical Group Co., Ltd.	Manufacturer product information page: Gemcitabine for Injection	Intravesical chemotherapy agent recorded in chemotherapy orders
Intravesical chemotherapy execution logs	Second Affiliated Hospital of Wenzhou Medical University	Not applicable; institutional treatment execution record	Source of instillation date, execution status, retention time, catheterization-related documentation, and cumulative instillation count
Microsoft Excel	Microsoft Corporation	https://www.microsoft.com/microsoft-365/excel	Data checking, preliminary data cleaning, table preparation, and verification of extracted variables
Mitomycin C for injection	Hospital-procured equivalent manufacturer	Institutional pharmacy procurement record	Intravesical chemotherapy agent recorded in chemotherapy orders
Pirarubicin hydrochloride for injection	Shenzhen Main Luck Pharmaceuticals Inc. or hospital-procured equivalent manufacturer	Institutional pharmacy procurement record	Intravesical chemotherapy agent recorded in chemotherapy orders
R package: geepack	CRAN	https://cran.r-project.org/package=geepack	Generalized estimating equation analysis for instillation-level clustered outcomes
R package: ggplot2	CRAN	https://cran.r-project.org/package=ggplot2	Generation of distribution plots and publication-ready statistical figures
R package: ipw	CRAN	https://cran.r-project.org/package=ipw	Stabilized inverse probability of treatment weighting for propensity-adjusted analyses
R package: logistf	CRAN	https://cran.r-project.org/package=logistf	Firth penalized logistic regression for small-sample robustness analysis
R package: MatchIt	CRAN	https://cran.r-project.org/package=MatchIt	Propensity-score matching sensitivity analysis
R package: survival	CRAN	https://cran.r-project.org/package=survival	Kaplan–Meier analysis, Cox proportional hazards modeling, and time-to-event analysis
R package: survminer	CRAN	https://cran.r-project.org/package=survminer	Visualization of Kaplan–Meier curves and number-at-risk tables
R package: tableone	CRAN	https://cran.r-project.org/package=tableone	Baseline characteristic tables and standardized mean difference calculation
R software, version 4.3.2	R Foundation for Statistical Computing	https://www.r-project.org/	Statistical analysis, regression modeling, time-to-event analysis, and figure generation
Urinalysis reports	Clinical Laboratory, Second Affiliated Hospital of Wenzhou Medical University	Not applicable; institutional laboratory information system	Source of baseline urine WBC, RBC, nitrite, leukocyte esterase, and infection-risk indicators
Urine culture reports	Clinical Laboratory, Second Affiliated Hospital of Wenzhou Medical University	Not applicable; institutional laboratory information system	Source of urine culture results used for infection-related phenotype classification