Assessment of Bladder Cancer Care Delivery Among Patients Undergoing Radical Cystectomy: TURBT Complexity, Treatment Timelines, and Follow-up Compliance
Main Article Content
Abstract
Objective: To evaluate complexity & completeness of transurethral resection of bladder tumor (TURBT), treatment timelines, and follow-up compliance among bladder cancer patients undergoing radical cystectomy.
Methodology: A retrospective observational cohort study, seventy patients; histologically proven bladder cancer, underwent primary TURBT & were later referred for radical cystectomy, were selected Pakistan Kidney & Liver Institute & Research Center, during the period of February 2023 to August 2025. The variables assessed included: complexity, completeness, perioperative complications, time to intravesical treatment/surgery, and time to follow-up (cystoscopy, radiological, urine cytology) using descriptive methods. The recurrence of the tumor was confirmed histologically after a tumor-free status.
Results: Male were predominant, 77.1%, mean age 54.1 ± 9.6 years. TURBT was complete in 71.4% of patients, while complex procedures were 18.6%. Intraoperative complications occurred in 26 (37.1%) patients, likely reflecting the high tumor burden and advanced disease stage within this radical cystectomy cohort. Follow-up was initiated in 57.1% of patients; cystoscopy was performed in 11.4%, and imaging in 45.7%. Disease recurrence occurred in 12.9% of patients, at a mean of 15.2 ± 14.1 months. Overall survival was 40.0%
Conclusion: In this cohort of patients with bladder cancer underwent radical cystectomy, there were inconsistencies in the documentation of TURBT procedure, treatment schedules, and follow-up practices. Such observations emphasize possible areas wherein there is need for improvement in the provision of care to patients with bladder cancer.
Article Details
Work published in JPMI is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
1. Waqar U, Jaffar R, Rafique T, Madad S, Khan S, Ahmed L. Bladder cancer in Pakistan: challenges in early diagnosis and multidisciplinary management. J Popul Ther Clin Pharmacol 2024;31(7):1020-7. DOI: 10.53555/jptcp.v31i7.7186.
2. Saeed S, Khan D, Faisal S, Rauf F, Ali MO, Rehman A. A histopathological and epidemiological study of urothelial carcinoma at a tertiary care centre in Peshawar, Pakistan. J Pak Med Assoc 2024;74(6):1160-2. DOI: 10.47391/JPMA.9546.
3. Nusrat NB, Rehman AU, Zafar N, Muhammad S, Bajwa SI, Imtiaz S. Challenges and technical aspects in the management of muscle invasive bladder cancer as retrograde radical cystectomy with ileal conduit. J Pak Med Assoc 2024;74(3):513-8. DOI: 10.47391/JPMA.9567.
4. Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, et al. Global Cancer Observatory: Cancer Today. In: Global Cancer Observatory [Internet]. Lyon (France): International Agency for Research on Cancer; 2024 [cited 2026 May 31]. Available from: https://gco.iarc.who.int/today
5. Ikram A, Pervez S, Khadim MT, Sohaib M, Uddin H, Badar F, et al. National Cancer Registry of Pakistan: first comprehensive report of cancer statistics 2015-2019. J Coll Physicians Surg Pak 2023;33(6):625-32. DOI: 10.29271/jcpsp.2023.06.625.
6. Nusrat NB, Muhammad S, Rehman AU, Zafar N, Aslam A, Imtiaz S, et al. Quality assessment of TURBT for non-muscle invasive bladder cancer: a single-center clinical audit. Pak J Urol 2024;2(2):142-8. DOI: 10.69885/pju.v2i02.81.
7. Malik IH, Bangash WG, Qazi SM. Superficial bladder cancer recurrence on first check cystoscopy after transurethral resection of bladder tumour (TURBT). J Rawalpindi Med Coll 2016;20(2).
8. European Association of Urology. EAU guidelines on non-muscle-invasive bladder cancer. Presented at the EAU Annual Congress Madrid 2025. Arnhem, The Netherlands: EAU Guidelines Office; 2025.
9. Hof JP, Kiemeney LALM, Aben KKH, van der Heijden AG, Vrieling A, Vermeulen SH. Recurrence patterns in a large contemporary cohort of patients with non-muscle invasive bladder cancer. Clin Genitourin Cancer 2026;24(1):102464. DOI: 10.1016/j.clgc.2025.102464.
10. Gontero P, Birtle A, Capoun O, Compérat E, Dominguez-Escrig JL, Liedberg F, et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ): summary of the 2024 guidelines update. Eur Urol 2024;86(6):531-49. DOI: 10.1016/j.eururo.2024.07.027.
11. Botros A, Rival PM, Davis ID, Sengupta S. A systematic review of the use of surgical checklists in transurethral resection of bladder tumour. Cancers (Basel) 2024;16(21):3626. DOI: 10.3390/cancers16213626.
12. Gorrepati R, Pal BC, Panda A. Transurethral resection of bladder tumor: elements of the surgical technique. UroCancer Clin India 2024;2(2):74-8. DOI: 10.4103/UCCI.UCCI_17_24.
13. Kumar M, Yadav A, Kumar K, Dhayal IR. Assessment of outcome and feasibility of bladder preservation therapy in muscle invasive bladder carcinoma: a prospective observational study with meta-analysis. Int J Med Res Health Sci 2022;11(6):30-52.
14. Jensen BT, Lauridsen SV, Jensen JB. Optimal delivery of follow-up care after radical cystectomy for bladder cancer. Res Rep Urol 2020;12:471-86. DOI: 10.2147/RRU.S270240.
15. Soukup V, Babjuk M, Bellmunt J, Dalbagni G, Giannarini G, Hakenberg OW, et al. Follow-up after surgical treatment of bladder cancer: a critical analysis of the literature. Eur Urol 2012;62(2):290-302. DOI: 10.1016/j.eururo.2012.05.008.