Introduction:

Intravesical chemotherapy is known to have an impact on patient urinary symptoms. Yet, how perioperative intravesical chemotherapy (PIC) administration following transurethral resection of bladder tumor (TURBT) affects recovery and return to baseline urinary symptoms is largely unknown. Using a novel ecological momentary symptom assessment platform that allows real-time evaluation of patient reported outcomes (PROs), we sought to assess if the postoperative recovery of patients who received PIC differed from patients who underwent TURBT without PIC administration.

Methods:

Patients scheduled for TURBT were prospectively identified and invited to enroll in our PROs program. Using a text-message based ecological momentary symptom assessment tool, patients were surveyed 7 days prior to procedure to establish a baseline and on postoperative days 1, 2, 3, 5, 7, 10, and 14. Survey questionnaires used a 5-point Likert scale and included 11 questions regarding urinary and catheter-related symptoms, functional outcomes, quality of life, and overall recovery. Study objectives were to compare postoperative recovery for patients undergoing TURBT with or without PIC. Cumulative incidence functions were used to estimate the time to return to baseline functional status for each survey question. Patients were considered to have returned to their baseline status on the postoperative day that their survey responses returned to or improved upon their baseline value. Cumulative incidence of recovery was compared using Gray’s test. Patients were excluded if they had significant postoperative complications.

Results:

Of 144 patients included in the analysis, 19 received PIC (gemcitabine). There were no differences between groups with regards to age, sex, and estimated total size of resection. Overall, we noted similar time to return to baseline functional status in most survey questions between patients with TURBT + PIC compared with TURBT alone. Patients treated with PIC reported longer time to “return to work” compared with the TURBT alone group (p=0.03, Figure 1). Patients who received PIC tended to have longer time to return to baseline functional status with regards to “bladder emptying” and “feeling recovered from surgery”, although this did not reach conventional statistical significance (p=0.065 and p=0.056, respectively). We noted similar time to recovery with regards to baseline function for “urinary frequency, urgency, dysuria, sleep, and quality of life” related questions.

Conclusion:

Using a novel ecological momentary symptom to record PROs, we noted patients treated with TURBT + PIC tended to have similar recovery and return to baseline functional status as patients treated with TURBT. Only small, and likely clinically insignificant, difference in recovery between these two groups were detected.

Funding: N/A