Prognostic Factors for Intravesical Recurrence in NMIBC: Evaluating the Role of Pyuria, Bacteriuria, and Comorbidities

Abstract

Background: The discovery of risk factors that might predict the recurrence of non-muscle invasive bladder cancer (NMIBC) is essential. Objectives: Therefore, this prospective cohort study aimed at examining the association between bacteriuria and pyuria before bacillus Calmette-Guérin (BCG) installation and the occurrence of intravesical recurrence (IVR) in patients diagnosed with NMIBC. Methods: A total of 73 NMIBC patients undergoing transurethral resection of bladder tumor (TURBT) and BCG treatment were included. Pre-instillation urine samples were analyzed for pyuria and bacteriuria. Results: The findings of this study indicated that preoperative pyuria was present in 31 (42.5%) of the studied patients. Furthermore, a statistically significant association was detected between preoperative pyuria and preoperative proteinuria (P < 0.001), preoperative hematuria (P = 0.023), preoperative bacteriuria (P = 0.001), and muscle invasion (MI) (P = 0.028). The results of the univariate analysis indicated substantial associations between the variables of smoking, diabetes, carcinoma in situ (CIS), age, and IVR. Subsequently, a multivariate analysis indicated that diabetes (HR = 18.11, P = 0.004) and CIS (HR = 14.69, P = 0.039) had a statistically significant link with IVR. Conclusions: In conclusion, our study demonstrated that diabetes, CIS, and younger age were the sole independent prognostic factors for IVR. Furthermore, no statistically significant association was observed between pyuria, bacteriuria, and smoking with bladder tumor recurrence. The analyses revealed that pyuria emerged as a statistically significant predictive factor for IVR only among individuals without pre-instillation proteinuria.