title: Follow-up after surgical treatment of bladder cancer: a critical analysis of the literature.
abstract: BACKGROUND
  Follow-up of patients treated for bladder cancer (BCa) is of great importance for both non-muscle-invasive BCa (NMIBC) and muscle-invasive BCa (MIBC) because of the high incidence of recurrence and progression. The schedule and methods of follow-up should reflect the individual clinical situation.
  
  
  OBJECTIVE
  To evaluate the existing evidence for intensity and duration of follow-up recommendations in patients after surgical treatment of BCa.
  
  
  METHODS
  We searched the Medline, Embase, and Cochrane databases for published data on the follow-up of patients with NMIBC and MIBC after radical cystectomy (RC).
  
  
  RESULTS
  Follow-up in patients with NMIBC is necessary because of the high probability of tumour recurrence and the risk of progression. Cystoscopy plus cytology are the standard methods for follow-up. Cystoscopy should be done 3 mo after the transurethral resection in every patient, and the frequency after that depends on the individual recurrence/progression risk. Cytology should be used as an adjunctive method to cystoscopy in intermediate- and high-risk patients. None of the currently available urinary markers or imaging methods can substitute for cystoscopy-based follow-up. High-risk NMIBC patients require regular lifelong upper urinary tract monitoring. Follow-up in MIBC is based on the fact that early detection of recurrence after RC allows for timely treatment with the aim of improving outcomes. Patients with extravesical and lymph node-positive disease should have the most intensive follow-up because of the highest recurrence risk. Routine upper urinary tract imaging is advisable for all patients and should continue in the long term. Follow-up also allows for early detection of urinary diversion-related complications, the rate of which increases with time.
  
  
  CONCLUSIONS
  Follow-up in BCa is necessary for diagnosing recurrence and progression, as well as for evaluating complications after radical treatment. Since randomised studies investigating the most appropriate follow-up schedule are lacking, most recommendations are based on only the retrospective experience. Nonetheless, reasonable recommendations can be made until further prospective randomised studies testing different follow-up schedules have been performed.
authors.affiliation: Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Praha, Praha, Czech Republic. viktor.soukup@seznam.cz
authors.forename: Viktor
authors.initials: V
authors.lastname: Soukup
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.forename: Harry
authors.initials: H
authors.lastname: Herr
authors.forename: Eric
authors.initials: E
authors.lastname: Lechevallier
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ribal
mesh_terms: D015415:Biomarkers / Q000652:urine; D001706:Biopsy; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D003558:Cystoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D015415:Biomarkers