Introduction:

Short-term symptomatic and functional recovery after transurethral resection of bladder tumors (TURBT) is very poorly understood. We sought to quantitatively evaluate patient-reported outcomes (PROs) during short term recovery from TURBT using data from a novel real-time education and symptom-assessment platform. 

Methods:

Beginning in April 2020, our institution implemented an automated system to improve preparation for and follow-up after TURBT. Patients received text messages at fixed days in the perioperative period linking them to a web-based interface which included instructions, educational materials, and PRO surveys. PROs were measured at baseline (7 days before surgery) and on postoperative days 1, 2, 3, 5, 7, 10, and 14. Patients were asked to rate their level of agreement with 9 statements on a 5-point Likert scale ranging from “Not at all” to “Very much”. p-values for differences from baseline were obtained using ordinal logistic regression models with generalized estimating equations for repeated measures within subjects. The statements “I have pain” and “I feel recovered from surgery” were not included preoperatively; therefore responses on postoperative day 14 were used as the referent for testing, reflecting an assumption that recovery has reached a plateau by this point.

Results:

106 patients were eligible and 78 participated in the monitoring system between April and August 2020. Results of PRO surveys are shown in Figure 1. 57, 59, 56, 60, 55, 58, 65, and 50 patients responded at each time point. 38 participants had biopsies or small resections (<2cm) and 40 had larger resections.  Of the urinary symptoms measured—dysuria, frequency of urination, loss of control of urination, and subjective difficulty with bladder emptying—only dysuria ever differed significantly from baseline.  Of the quality of life measurements—ability to work, ability to sleep, and overall quality of life—only ability to work declined significantly, but this returned to baseline by postoperative day 3. Overall quality of life and ability to sleep actually improved from baseline on postoperative day 7 and 14. Pain reached plateau by postoperative day 2, but subjective recovery did not plateau during the study period. 

Conclusion:

Prospectively collected PROs using a novel real-time symptom assessment platform reveal that symptoms and functional decline are generally mild and short-lived following TURBT.  Patients undergoing TURBT actually experience improved sleep and overall quality of life compared to baseline in the short term. These findings may inform early identification of patients deviating from the usual postoperative course. Further work is needed to determine how clinical and oncologic factors may affect recovery. 

Funding: N/A