Stage specific follow-up strategy after cystectomy for carcinoma of the bladder. : Int J Urol 2002;9:129–133.

Abstract

Background: Follow-up strategies after cystectomy for carcinoma of the bladder should be determined according to the risk of recurrence, which is stage dependent. We aimed to develop follow-up protocol for monitoring patients with carcinoma of the bladder for tumor recurrence and diverted urinary tract complications after radical cystectomy. Methods: The records of 351 patients with carcinoma of the bladder who underwent cystectomy between 1979 and 1999 were reviewed for dates and presenting symptoms of local and distant recurrences. The results of imaging studies and blood tests were also reviewed. Based on the division of patients into pathological stages of pT 1 and lower, pT 2, and pT 3 and higher groups, we proposed a new follow-up schedule for carcinoma of the bladder. Results: The risk of metastasis was related to the pathological stage of the primary tumor. Recurrence developed in 10 of 124 patients (8%) with pT 1 or lower, 17 of 101 patients (17%) with pT 2, and 55 of 101 patients (54%) with pT 3 or higher disease at a median of 11 (range 6–186), 10 (1–40), and 7 (1–76) months, respectively. Recurrences in patients with pT 3 or higher were found earlier and more frequently than those with pT 2 or lower. Of 82 patients with metastases, 54 initially were symptomatic, and three of pT 1 or lower, six of pT 2, and 19 of pT 3 or higher were asymptomatic. Based on these results we proposed a stage-specific follow-up protocol. Conclusions: A stage-driven follow-up strategy for monitoring patients after radical cystectomy can reduce medical expenses while efficiently detecting recurrences and complications.