Editing CUA: Muscle-invasive Bladder Cancer (2019) (section)

== Follow-up and Quality-of-Life ==

* '''Quality of Life (QOL) in the form of a validated Patient Reported Outcome (PRO) measure or QOL instrument should be captured for all patients at each visit.'''
** '''A recent study suggested improved survival in patients reporting PROs.'''
** Cystectomy patients are at risk of long-term sexual dysfunction, urinary complications (recurrent infections, uretero-enteric anastomotic strictures, stones, renal failure) and bowel dysfunction (diarrhea or constipation).
** TMT patients may experience sexual dysfunction, voiding and storage symptoms from urethral strictures or radiation cystitis, or bowel toxicity (radiation enteritis or proctitis).
** Downstream toxicity from perioperative chemotherapy may also occur (e.g. coronary artery disease, peripheral neuropathy, ototoxicity).
* '''Follow-up schedules should be tailored to final pathologic TNM staging'''
* '''Follow-up visits after radical cystectomy should include:'''
** '''Imaging:'''
*** '''Metastasis'''
*** '''Upper tract to assess for hydronephrosis or recurrence'''
** '''Laboratory:'''
*** '''Detect metabolic complications of diversion'''
** '''In patients at high risk for urethral or upper tract recurrence, urethral washings +/- urethroscopy and urine should be collected for cytologic examination at interval follow up visits'''
* '''Patients treated with a bladder preservation approach (radiotherapy-based or partial cystectomy) should also receive,''' in addition to the same investigations performed for radical cystectomy patients, '''long term cystoscopic evaluation at each follow up visit to survey the remaining urothelium'''
* '''Intravesical recurrences after bladder preservation may be managed as per primary bladder tumours based on pathologic assessment after TURBT. Careful consideration for radical cystectomy should occur for high risk recurrences.'''