In this paper, we asked patients questions about their symptoms and functional status before they underwent transurethral resection of bladder tumors and then asked the same questions on specified days after surgery.
The figures do a good job of giving the headline results here, but to give some highlights:
- Ability to sleep, overall quality of life, continence, and ability to completely empty the bladder don’t seem to be hurt much by surgery.
- Dysuria (burning with urination) was the most significant symptom after surgery. It tends to be mild -- increasing from an average response of 1/5 (“not at all”) preoperatively to a 3/5 (“somewhat”) on postoperative day 1 on average -- but it can linger.
- For every symptom we asked about, >50% of patients felt fully recovered by the second day after surgery, regardless of whether they had a big or a small tumor removed. 80% felt fully recovered by the end of the first week. By the end of two weeks the vast majority of patients felt fully recovered, but not all.
- Ability to work followed basically the same pattern. (I think is important to highlight because “how long to I have to take off of work” and “is this going to interfere with my vacation” are two of the most common questions I get in my clinic)
- Most patients are back to peeing clear yellow by the day after surgery, but pink or brown urine is very common in the first week after surgery and rarely can extend even longer. (Though we didn’t see any evidence that having pink or brown urine for longer was a problem.)
The other finding that I find most interesting is that chemotherapy (gemcitabine) instillation at the time of surgery was associated with longer recovery in our data. This finding really requires confirmation with more studies before I would suggest that it should influence anyone’s clinical decision making, but I do think it’s worth looking into. Trials like SWOG S0337, which led to our use of gemcitabine in this setting, look at big things like adverse events and mortality but generally don’t look at differences like a few days of recovery time which seem small but of course, are very important when you are the one recovering.
Figure 2: Symptoms postoperative day and size of resection. Points and error bars show means and standard deviation respectively. The dotted line shows the pre-operative baseline (work = ability to work, sleep = ability to sleep, QoL = satisfaction with quality of life, burning = burning with urination, frequency = increased frequency of urination, control = ability to control urination, emptying = difficulty completely emptying bladder, pain = overall pain, recovered = subjective overall recovery)
Figure 3: Percent of patients who feel back to baseline by postoperative day.
Written by: Marshall Strother, MD, Department of Urology, Fox Chase Cancer Center, Philadelphia, PA.
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