Upper tract surveillance in primary bladder cancer follow‐up

Abstract

use surveillance in selected patients, i.e. those with carcinoma in situ (47%), multiple bladder tumours at first presentation (39%) and after cystectomy (70%), and 118 (39%) use upper tract surveillance on all patients with a history of bladder cancer. The median (range) screening interval was 24 (12-60) months and surveillance continued for a median of 10 (2 to indefinite) years, continuing for an indefinite period in 33%. CONCLUSIONSMost urologists use upper tract surveillance in patients with bladder cancer but there is wide variation in the duration and interval for which it continues, and in the type of patient selected for surveillance. Some patients at high risk of upper tract tumour are not being screened. Asymptomatic upper tract tumours may not be diagnosed because the intervals between surveillance are too long, and the duration for which it continues inadequate. There is a need for multidisciplinary national guidelines to reduce variation in practice. KEYWORDSupper urinary tract cancer; bladder cancer; surveillance OBJECTIVETo determine if there is national variation in regimens of upper urinary tract surveillance in patients with primary bladder cancer. METHODSA questionnaire was sent to 470 consultant urologists from a British Association of Urological Surgeons list in the UK; 301 anonymous replies were received. Two replies were incomplete and therefore the results of 299 questionnaires (64%) were analysed. RESULTSOf the 299 surgeons, 19 (6%) use no form of upper urinary tract surveillance; 162 (54%)

Limited significance of routine excretory urography in the follow‐up of patients with superficial bladder cancer after transurethral resection

“…To date, there seems to be no established protocol to detect secondary UUTCs after TUR of superficial bladder cancer. In particular, the significance of routine IVU has been controversial [1,2,6–9,13], e.g. Wlazer and Soloway [8] reported that routine follow‐up IVU was neither cost‐effective nor necessary, considering the low incidence of UUT recurrence.…”

“…Although the risk of UUT recurrence after TUR for superficial bladder cancer is low, at 2-6% [1][2][3][4][5], most urologists use UUT surveillance in patients treated by TUR for superficial bladder cancer. However, there is wide variation in the categories used for patient selection, and in the duration and interval for which surveillance continues [6][7][8][9]. For example, based on responses to a questionnaire from 301 urologists in the BAUS, Enver et al [9] reported that 54% of urologists use surveillance in selected patients, while 39% use UUT surveillance in all patients with a history of bladder cancer.…”

“…Although one of the most important characteristics of urothelial carcinoma is the tendency to multifocal location, the incidence of upper urinary tract (UUT) recurrence in patients with superficial bladder cancer after transurethral resection (TUR) is relatively low, at 2-6% [1][2][3][4][5]. Hence, several investigators have analysed the clinical outcomes of longterm follow-up for patients with superficial bladder cancer focusing on the secondary development of UUT cancer (UUTC) to establish the optimum surveillance strategy for such patients [6][7][8][9]. The primary objective of upper tract surveillance is to identify UUTCs at an early stage in asymptomatic patients, so that curative treatment can be offered.…”

A comparison of the performance of microsatellite and methylation urine analysis for predicting the recurrence of urothelial cell carcinoma, and definition of a set of markers by Bayesian network analysis

“…If there was no evidence of a tumour on cystoscopy, but the mucosa had an abnormal appearance or if cytology findings were positive, bladder biopsies were taken. If the biopsies were negative, the UUT was explored by CT and/or ureteroscopy [4]. We defined a recurrence either in situ in the bladder or in the UUT as local recurrence.…”

Multiple factor analysis of metachronous upper urinary tract transitional cell carcinoma after radical cystectomy

“…These studies were performed in patients submitted to radical cystectomy because of various types of bladder cancer. In addition, the lack of guidelines regarding patient selection and the interval and duration of surveillance results in wide variations in practice (10). There are no studies assessing the prognostic factors for metachronous UUT TCC after radical cystectomy for primary invasive bladder cancer by multivariate analysis.…”