J82 monolayer cell cultures and 647 V multicellular tumor spheroids were incubated in Resectal, urine (pH 5.5; 7.5) and distilled water for 5-30 min. In the case of both monolayers and tumor spheroids inhibition of tumor cell growth was achieved by incubation in distilled water. Transurethral resection (TUR) of a primary superficial bladder cancer was performed in 133 patients (Ta, T1). In 60 of these patients selected biopsies of apparently normal bladder mucosa were taken at the same time. There was no significant difference in tumor recurrence between the groups with biopsy and without biopsy. However, all patients with dysplasia in the selected mucosal biopsies developed a tumor recurrence. Between 1969 and 1984 bladder wall perforation occurred in 12 patients during TUR of Ta, T1 bladder cancer. None of the patients who experienced bladder wall perforation developed extraperitoneal or intraperitoneal metastases. Although our clinical results suggest that iatrogenic tumor cell implantation during TUR of a bladder cancer is rather unlikely, this event could be prevented by the use of distilled water during and after TUR.
