PROPOSAL FOR CHANGES IN CYSTOSCOPIC FOLLOW-UP OF PATIENTS WITH BLADDER-CANCER AND ADJUVANT INTRAVESICAL CHEMOTHERAPY

A famous surgeon observed that the most important instrument for the m anagement of superficial bladder cancer was a typewriter because it fa cilitated the organisation of the regular follow up examinations that are so important in controlling this disease. Cystoscopic follow up mu st be lifelong, and the cost, in the broadest sense, to both patient a nd health service is considerable. A recent study has suggested that t he conventional frequency of bladder examinations may not be necessary and that most patients could be spared many cystoscopies. Instillatio n of cytotoxic drugs in the bladder has been shown to reduce the recur rence of tumours destroyed endoscopically and the development of new t umours elsewhere in the bladder. Because intravesical instillations ar e inconvenient, expensive, and may be toxic they have been reserved fo r patients thought to be at greatest risk of recurrence. However, two clinical trials have shown that a single cytotoxic instillation may be beneficial for low risk patients. If this is verified in everyday pra ctice, the routine use of intravesical chemotherapy for all patients a t the time of initial treatment could reduce the need for cystoscopies even further. Such changes should improve the quality of life of the 7000 new patients with superficial bladder cancer each year in England and Wales and allow savings to be made in the NHS.