In a smaller study of 343 patients, 46% (158) of patients developed recurrence; 30% (104) were distant, 6% (21) were distant and local, and 10% (33) were only local. Eighty-four percent of recurrences were identified within 2 years. Following cystectomy, patients are also at risk of developing UTUC, which is found in up to 3.7% of patients [47,48]. As recurrence can involve the entire urinary tract, the urethra also needs to be screened, often with urethral wash cytology, although urethral recurrence may occasionally be identified on cross- sectional imaging. The risk of urethral recurrence is 2.7% to 3.8%, and risk factors include prostatic involvement of the MIBC [47-49]. CT Abdomen and Pelvis As described earlier, recurrences can be described as pelvic relapse; surgical bed recurrence; internal and external iliac and obturator lymph node involvement or distant metastatic disease; and osseous, pulmonary, hepatic, extrapelvic lymphadenopathy, peritoneal, and brain metastases. There is no relevant literature regarding the use of CT abdomen and pelvis without or with IV contrast for the evaluation of metastatic bladder cancer; however, in the absence of contraindications, IV contrast is generally indicated to improve sensitivity for the identification of metastatic disease. CT of the abdomen and pelvis without and with IV contrast (excluding CTU) adds little over CT abdomen and pelvis with IV contrast and does not offer a complete examination of the urinary tract. CT Chest All patients with MIBC require imaging of the thorax. In the setting of bladder cancer, there is a lack of data comparing the utility of chest radiography and chest CT. Chest radiography is an effective screening examination and should be performed at regular intervals. Any abnormality identified at radiography should be followed up with a CT examination for improved characterization.
Post Treatment Surveillance of Bladder Cancer. In a smaller study of 343 patients, 46% (158) of patients developed recurrence; 30% (104) were distant, 6% (21) were distant and local, and 10% (33) were only local. Eighty-four percent of recurrences were identified within 2 years. Following cystectomy, patients are also at risk of developing UTUC, which is found in up to 3.7% of patients [47,48]. As recurrence can involve the entire urinary tract, the urethra also needs to be screened, often with urethral wash cytology, although urethral recurrence may occasionally be identified on cross- sectional imaging. The risk of urethral recurrence is 2.7% to 3.8%, and risk factors include prostatic involvement of the MIBC [47-49]. CT Abdomen and Pelvis As described earlier, recurrences can be described as pelvic relapse; surgical bed recurrence; internal and external iliac and obturator lymph node involvement or distant metastatic disease; and osseous, pulmonary, hepatic, extrapelvic lymphadenopathy, peritoneal, and brain metastases. There is no relevant literature regarding the use of CT abdomen and pelvis without or with IV contrast for the evaluation of metastatic bladder cancer; however, in the absence of contraindications, IV contrast is generally indicated to improve sensitivity for the identification of metastatic disease. CT of the abdomen and pelvis without and with IV contrast (excluding CTU) adds little over CT abdomen and pelvis with IV contrast and does not offer a complete examination of the urinary tract. CT Chest All patients with MIBC require imaging of the thorax. In the setting of bladder cancer, there is a lack of data comparing the utility of chest radiography and chest CT. Chest radiography is an effective screening examination and should be performed at regular intervals. Any abnormality identified at radiography should be followed up with a CT examination for improved characterization.