Acidic urine as a prognostic factor after intravesical Bacillus Calmette-Guerin induction therapy for nonmuscle-invasive bladder cancer

Abstract

Purpose: To investigate the effect of acidic urine (pH <= 5.5) on disease recurrence or progression in patients with nonmuscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guerin (BCG) induction therapy. Methods: A total of 578 patients with intermediate- and high-risk NMIBC who underwent intravesical BCG induction after initial TURBT between May 2003 and April 2021 were included. Patients were subdivided into low (pH <= 5.5) and high (pH > 5.5) urine pH groups. Results: Patients with acidic urine showed higher fasting plasma glucose levels (p = 0.017), higher serum uric acid level (p = 0.011), lower estimated glomerular filtration rates (p = 0.022), and higher rates of abnormal urinary cytology (p = 0.021), but no significant differences were observed in context of adverse clinicopathological features. During a median follow-up period of 56 months, the acidic urine group had a lower recurrence-free survival rate than the high urine pH group (p = 0.009). In terms of disease progression, there was no difference according to urine pH status. Conclusion: Acidic urine was associated with disease recurrence after intravesical BCG induction for NMIBC, despite no differences in adverse clinicopathological features according to urine acidity.