Many patients are confused about how to follow up after bladder cancer surgery. Let’s take a look at how to follow medical advice for follow-up after different surgeries for bladder cancer in order to detect recurrence, metastasis or complications this early, improve quality of life and prolong survival time.
Surgery for bladder cancer is divided into two major categories: one is surgery to preserve the bladder, such as transurethral resection of bladder tumor (TURBT) and partial cystectomy; the other is surgery for total bladder removal, such as open radical cystectomy and laparoscopic radical cystectomy. The timing and content of the different surgical follow-ups are discussed separately below.
I. After cystopexy In the follow-up after cystopexy, cystoscopy is still the gold standard, and urologists should help patients overcome their fears and undergo cystoscopy as much as possible, taking a soft cystoscope for cystoscopy can minimize the patient’s pain. Ultrasound, urinary exfoliative cytology and IVU have some value in the follow-up of non-muscle invasive bladder cancer, but they cannot completely replace the status and role of cystoscopy.
1. All patients should have cystoscopy as the primary follow-up and receive the first review at 3 months after surgery.
2. Patients with low-risk tumors who have a negative cystoscopy for the first time (3 months postoperatively) should receive a second follow-up 9 months later (1 year postoperatively), and then annually thereafter until 5 years.
3.Patients with high-risk tumors will be followed up every 3 months in the first 2 years, every 6 months from the third year, and annually from the fifth year until lifetime.
4. Patients with intermediate risk tumor should be followed up every 3 months in the first year, every 6 months in the second year, and then once a year for 5 years.
After radical cystectomy Patients with bladder cancer must have long-term follow-up after radical cystectomy and urinary diversion. The focus of follow-up includes tumor recurrence and complications related to urinary diversion.
The risk of tumor recurrence and progression after radical cystectomy is primarily related to histopathologic staging, with local recurrence and progression and distant metastasis being highest in the first 24 months after surgery, gradually decreasing from 24 to 36 months, and relatively low after 36 months. Tumor recurrence is easily detected by regular imaging examinations, but the question of how often to perform examinations remains controversial. Some scholars recommend annual physical examination, blood biochemistry, chest X-ray and ultrasound (including liver, kidney, retroperitoneum, etc.) for patients with pT1 stage tumor; 6 months for patients with pT2 stage tumor and every 3 months for patients with pT3 stage tumor. In addition, pelvic CT examination should be performed every six months for patients with pT3 stage tumor. It should be especially noted that upper urinary tract imaging is valuable to rule out the presence of ureteral strictures and upper urinary tract tumors, which are uncommon but often require surgical treatment once detected.
Follow-up of patients with urinary diversion after radical cystectomy is mainly concerned with surgery-related complications (e.g., reflux and stricture), substitution-related metabolic problems (e.g., anemia and peripheral neuropathy due to vitamin B12 deficiency), urine storage-related metabolic problems (water-electrolyte disturbances), urinary tract infections, and secondary tumor problems (e.g., upper urinary tract and bowel).
1, Patients after radical cystectomy should be followed up for life.
2, Follow-up interval: pT1 stage once a year, pT2 stage once every 6 months, and pT3 stage once every 3 months.
3. The follow-up should include physical examination, blood biochemical examination, chest X-ray examination and ultrasound examination (including liver, kidney, retroperitoneum, etc.). For pT3 stage tumor patients, pelvic CT examination can be chosen every six months. Upper urinary tract imaging may be chosen to exclude the presence of ureteral strictures and upper urinary tract tumors.
4. Follow-up of patients after urinary diversion revolves around surgery-related complications, metabolic complications, urinary tract infections, and secondary tumors.
Daily care and health care for patients with ileal bladder transit: Because the patient’s urine flows from the abdominal wall ileostomy, a urine collector needs to be permanently placed. The urine collector consists of two parts, the sump and the urine bag, and the sump is usually replaced once in several days, and the urine bag is replaced once in 1-2 days. Care should be given to: (1) those with permanent skin fistula should protect the skin around the stoma, wash and disinfect daily, and apply zinc oxide ointment etc.; (2) when flocculent mucus is found in the urine, you can drink more water and take baking soda tablets orally to alkalize the urine and thin the mucus to facilitate smooth urination; (3) comprehensive review every 3 months for 2 years after surgery and every 6 months after 2 years; (4) pay attention to the occurrence of retrograde urinary tract infection, and if there is sudden high fever, timely hospital consultation is also required; (5) if there is bloody discharge from the urethra, the possibility of residual or occurrence of urethral tumor should be alerted, and timely hospital consultation should be made.