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Sir,

We read with interest this article [1] describing a novel technique of intravesical administration of mitomycin C, and discussing the advantages of using this device, e.g. safe and timely administration and no further need for specialist pharmacy staff or equipment. This delivery system (MITO-INTM) was used in 27 patients, with 19 receiving one instillation and eight a 6-week course. The authors state that delivery was possible within 1 h after surgery but the exact timing and patient location during administration was unclear. They concluded that the device should increase the proportion of patients who are able to receive intravesical mitomycin C within 24 h of first bladder tumour resection. As intravesical mitomycin C is reported to reduce tumour reimplantation after resection [2], immediate administration after TURBT is theoretically advantageous. We have therefore prospectively administered intravesical mitomycin C using the MITO-IN delivery system in 50 consecutive patients immediately after TURBT, in theatre and whilst still scrubbed (Fig. 1). The technique allowed immediate and safe delivery of the agent within a sterile environment. After delivery the catheters were clamped and the patients returned to the recovery ward; the catheter was unclamped after 1 h and the catheter bag (containing the cytotoxic agent) disposed of appropriately. Catheters were removed at either midnight or the next morning. All patients were able to void spontaneously and were discharged; no patients had suprapubic discomfort, chemical cystitis, haematuria or clot retention during or after intravesical administration of mitomycin C. We agree with the authors [1] that the MITO-IN delivery system overcomes the logistic and safety concerns about the postoperative ward administration of mitomycin C. Furthermore, we have shown that the immediate delivery of mitomycin C after TURBT using this novel delivery system is feasible, eliminates the possibility of a missed dose and potentially increases its efficacy. We propose that all patients undergoing TURBT who would receive Mitomycin C on the ward within 24 h should have immediate intravesical instillation in theatre, using the MITO-IN delivery system.

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Figure 1. The immediate administration of mitomycin C after TURBT using the MITO-IN delivery system.

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  • 1
    McLarty E, Coker CB. A novel device for reconstituting and delivering intravesical chemotherapy. BJU Int 2003; 91: 575 6
  • 2
    Tolley DA, Parmar MKB, Grigor KM, Lallemand G and MRC Superficial Bladder Cancer Working Party. The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of followup. J Urol 1996; 155: 123338