What is included in the surveillance for recurrent bladder cancer following treatment of in situ carcinoma?

Updated: Sep 10, 2019
  • Author: David A Levy, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

Following successful treatment of initial or recurrent carcinoma in situ (CIS) with intravesical bacillus Calmette-Guérin (BCG) vaccine, chemotherapy, or both, patients are monitored at regular intervals with cystoscopy and urine cytology, usually every 3 months for the first 1-2 years and every 6 months thereafter. Intravenous pyelography (IVP) is also usually performed every 6-12 months. This follow-up continues for a minimum of 5 years.

Following cystectomy and urinary diversion, cytology is performed every 3 months for the first 1-2 years and every 6 months thereafter. In patients with a urostomy or continent diversion, a catheterized specimen is obtained from the stoma, not the urostomy bag, because contact with the bag and the stagnant nature of urine in the bag confounds the cytologic findings.

If the patient did not undergo a urethrectomy, a urethral wash for cytology should also be performed on this schedule. Patients with an intestinal neobladder should provide a voided specimen. IVP or loopography should be performed every 6-12 months to evaluate the upper urinary tract, as should CT scanning, chest radiography, and serum chemistry studies to rule out metastatic disease. After 2-3 years, a vitamin B-12 level should be checked because many of these patients develop deficiency of this vitamin.


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