Editing Non-Muscle Invasive Bladder Cancer (section)

== Surveillance and Prevention ==

* <span style="color:#ff0000">'''See'''</span> '''[[CUA/AUA: Non-muscle Invasive Bladder Cancer (2021 CUA/2016 AUA))|2016 AUA/2021 CUA NMBIC]] <span style="color:#ff0000">Guideline Notes</span> on recommendations for surveillance, which are based on risk-classification'''
* At 10 years, ≈30% of patients remain free of tumor progression or recurrence, so close follow-up is mandatory
* Most protocols include cystoscopy and urinary cytology every 3 months for 18-24 months after the initial diagnosis, then every 6 months for the following 2 years, and then annually, resetting the clock with each newly identified tumor
** Most studies and a meta-analysis have failed to identify benefit of intraurethral injection of local anesthetics at the time of cystoscopy, and two recent studies actually found that pain experience was higher with the use of local anesthetics than in patients cystoscoped using aqueous lubricant alone. Considering the fact that anesthetic agents can partially cloud visualization, this ubiquitous practice should be reconsidered.
** Use of a video monitor allows the patient to see and understand the findings, theoretically distracting them from any discomfort. Men who are able to do so tolerate the procedure with ≈50% less pain than those who cannot see their findings on the monitor. This has not been found to be of significant benefit in women, probably because of the straighter urethra
** Although not indicated for routine screening and evaluation of asymptomatic microscopic hematuria, urinary cytology may be used in the surveillance of bladder cancer for certain patients as it possesses a high sensitivity and positive predictive value for high-grade tumors and CIS
* '''Extravesical surveillance'''
** '''<span style="color:#ff0000">Incidence of UTUC after bladder cancer: 3% (range 1.6% (low-risk) to 4.1% (high-risk))</span>'''
** <span style="color:#ff0000">'''See'''</span> '''[[CUA/AUA: Non-muscle Invasive Bladder Cancer (2021 CUA/2016 AUA))|2016 AUA/2021 CUA NMBIC]] <span style="color:#ff0000">Guideline Notes</span> on recommendations for upper-tract surveillance'''
** Modality: CT and intravenous urography
* '''Prostatic urethral UC'''
** Secondary tumor involvement of the prostatic urethra and ducts by UC may be detected in 10-15% of patients with high-risk non–muscle-invasive disease within 5 years and in 20-40% within 10 years.
** Management
*** See Urothelial Carcinoma of the Prostate Chapter Notes
*** Involvement of the prostatic ducts by low-grade urothelial should usually be managed by complete TURP for disease eradication and to facilitate contact of intravesical therapy to the prostatic urethra.
*** Involvement of the ducts by high-grade disease is best managed by radical cystoprostatectomy +/u urethrectomy