Elevated urinary fibronectin levels after transurethral resection of bladder tumour: a possible role in patients failing therapy with bacillus Calmette-Guerin

Objective To investigate fibronectin levels in urine samples from patients with noninvasive transitional cell carcinoma (TCC) of the bladder immediate ly and for 4 weeks after transurethral resection of bladder tumour (TURBT), to determine whether soluble fibronectin within the bladder, which blocks the attachment of bacillus Calmette-Guerin (BCG), might lower the efficacy of BCG therapy over this period. Patients and methods Urinary fibronectin was measured using an enzyme-linke d immunosorbent assay in 25 patients with superficial bladder TCC who under went TURBT for complete resection. Eight samples were collected for each pa tient, one before and seven during the 4 weeks after TURBT. Results High levels of urinary fibronectin were detected in 18 patients (72 %) after TURBT. In 16 patients the fibronectin level returned to normal wit hin 2 weeks of surgery. The other two patients showed elevated levels of fi bronectin for > 4 weeks. Conclusions These results show that urinary fibronectin concentration is si gnificantly increased in most patients after TURBT and this should be consi dered in patients who receive BCG therapy. Treatment within the first 2 wee ks after TURBT may be associated with a high failure rate, as urinary fibro nectin levels were increased significantly in about three-quarters of these patients during that period. Indeed, the persistent elevation of fibronect in, occurring in two of the present patients, may be responsible for some o f the failures of BCG therapy when it is administered 2-5 weeks after surge ry.