Bacillus Calmette‐Guérin or mitomycin C for treatment of non | Figure 1

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Bacillus Calmette‐Guérin or mitomycin C for treatment of non‐muscle‐invasive bladder cancer

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Review question

In people with cancer of the inner lining of the bladder, how do two different medicines, that are called Bacillus Calmette‐Guérin (BCG) and mitomycin (MMC), that are put into the bladder, after the tumour is taken out, compare?

Background

Tumours of the superficial layers of the bladder, so‐called non‐muscle‐invasive bladder cancer, are treated by putting small instruments into the bladder and shaving them out. This works well but these tumours often come back. When they do come back they can be more aggressive and advanced than before. Different types of medicines put into the bladder afterwards can make that happen less often, with BCG and MMC being those used most often. We are not sure how the two treatments compare when it comes to wanted and unwanted effects.

Study characteristics

The content of this review is current to September 2019. We included only studies where chance determined what treatment people in the study would get.

Key results

We found 12 studies including 2932 people who matched our question.

We found that BCG may lead to similar risk of dying from any cause over time (low‐quality evidence), but may increase the risk of serious unwanted effects (low‐quality evidence), although it is possible that it does not make a difference.

BCG may reduce the risk that the tumour comes back over time (low‐quality evidence), although it is possible that it does not make a difference.

BCG may have little or no effect on the risk that the tumour gets worse over time (low‐quality evidence).

We found no data on quality of life.

Quality of the evidence

The quality of the evidence was consistently rated as low, meaning that our confidence is limited, and future research may change these findings.

Read the full Cochrane Review here

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\ \ Comparison of two treatment options for kidney stones\ How are kidney stones treated?\ People with large kidney stones often need treatment. Two common ways to treat them are called percutaneous lithotripsy (PCNL) and retrograde intrarenal surgery (RIRS). PCNL involves placing a small tube from the skin into the kidney and then using different instruments to break up and remove the stones. RIRS involves placing a long viewing tube through the urethra (the tube connecting the bladder to the outside of the body) and the ureter (the tube connecting the bladder and the kidney) into the kidney, then using different instruments to break up and remove the stones. It is unclear how the two treatments compare.\ What did we want to find out?\ We wanted to know if PCNL was better than RIRS for treating kidney stones.\ What did we do?\ We searched for studies that compared PCNL with RIRS in adults with kidney stones of any size and located in any part of the kidney.\ What did we find?\ We found 42 studies that randomly allocated participants to either PCNL or RIRS. There were 4571 participants in total. The average age of participants was between 27.7 years and 59.3 years, and the average stone size was between 10.1 mm and 39.1 mm.\ Main results\ We found that compared with people treated with RIRS, people treated with PCNL may be more likely to be free of stones after the procedure and less likely to need another procedure to remove remaining stones. PCNL probably does not increase the risk of serious complications, although it may result in a longer hospital stay. We also found that people treated with PCNL may be no more likely to have a stricture of the ureter than people treated with RIRS. We did not find any evidence for unplanned medical visits or quality of life.\ What are the limitations of the evidence?\ We have little confidence in the evidence for most results, mainly because the studies were not well planned or carried out and because the results varied considerably across studies.](https://app.figure1.com/case-detail/1222e13b-b9b7-4b0f-8f23-5c0ec9b79d11)

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