Trimodality Therapy and Objective Long-term Bladder-Related QOL

Recent data being presented at the Society of Urologic Oncology Annual Meeting suggest good quality of life (QOL) outcomes for patients with muscle-invasive bladder cancer (MIBC) after trimodality therapy.

Trimodality therapy for MIBC is a guideline-suggested alternative option to radical cystectomy. However, limited bladder-related QOL data exist, and further research is needed to better understand objective secondary long-term trimodality therapy outcomes affecting QOL.

Jillian Egan, MD, and colleagues conducted a retrospective review of an institutional database for occurrences of bladder stones, gross hematuria (GH), recurrent urinary tract infection (UTI), and ureteral stricture. A total of 271 patients were included in the review.

A bladder stone was defined as any report of calcification in the bladder after trimodality therapy. Patients who presented to the emergency department at least once were counted as having GH. Recurrent UTI was defined as 2 infections within 6 months or 3 infections within 12 months and was only evaluated in patients who retained their bladder over the follow-up period. Ureteral strictures that occurred following salvage cystectomy were not included in the review.

Researchers noted that 83.8% (n=227) of patients retained their bladder at a median follow-up of 51.8 months (interquartile range [IQR], 18.0-98.1). A total of 6 patients underwent cystectomy for benign causes, including refractory lower urinary tract symptoms and poor bladder function, GH, or nonhealing fistula.

Bladder stones occurred in 8.5% (n=23) of patients at a median time of 15.2 months (IQR, 8.3-23.6). No treatment was needed in 10 of these patients, while 1 patient required cystolitholapaxy and 12 patients had the stones removed endoscopically with forceps or irrigation.

GH was reported in 18.8% (n=49) of patients, with 13 not needing treatment, 12 requiring catheter placement and hand irrigation, 14 needing continuous bladder irrigation, 5 requiring operative intervention, and 5 requiring transfusion.

Only 5.3% (n=14) of patients developed ureteral stricture at a median time of 27.8 months (IQR, 8.6-61.4). Of these, 13 were managed with ureteral stents and only 1 required a percutaneous nephrostomy tube.

Researchers added that 8.4% (n=19) experienced recurrent UTI.

“The rates of objective bladder-related complications affecting QOL after trimodality therapy are relatively low,” Dr. Egan and colleagues concluded, adding that “the risk of developing an ‘end-stage bladder’ requiring cystectomy and diversion” was also low. These results led them to suggest that patients with MIBC receiving trimodality therapy experience good QOL outcomes.