You should expect to return to your doctor for re-evaluation and further tests for some time after treatment and surgery. After you complete your initial evaluation and treatment for NMIBC, your healthcare provider may bring you back in, within three to four months, for a cystoscopy to see how you are doing. This helps him/her evaluate if the entire tumor was removed and assess your risk for the tumor to recur.
If your healthcare provider stages you as low-risk for cancer progression, then you will be asked to return, usually in three months, just for a surveillance scope of your bladder.
If you are an intermediate-risk patient, then your healthcare provider may ask you to return for a cystoscopy with cytology every 3-6 months for two years, then 6-12 months for three to four years, and then every year after. Cytology is the examination of cells from the body under a microscope. If you are intermediate to high risk, your urologist may place you on maintenance therapy as described before.
If you are high-risk for cancer progression, your healthcare provider may bring you back every three to four months for two years, then six months for three to four years, and then every year after.
You may also be given imaging tests as your healthcare provider sees fit. These imaging tests will be done to look for cancer in your kidneys and ureters.
If you had surgery, it takes time to heal. The time needed to recover is different for each person. It is common to feel weak or tired for a while. However, like any other major surgery, bladder surgery may have complications. Older patients and women are more likely to get complications after cystectomy.
There are some things you can do before surgery to help your recovery. If you smoke, try to get help so that you can quit before and after surgery. You also need to make sure you eat right so that your body can heal and can cope with the changes.
Here are some possible problems you may have after treatment:
- Gastrointestinal (GI) problems: Your bowel function may return more slowly after your surgery. This often happens after abdominal surgery. Your surgeon and other healthcare providers will take steps to monitor bowel function and avoid GI problems.
- Urinary diversion: Urinary diversion following bladder surgery may present challenges for which you should prepare yourself. You may need to learn how to remove urine from your body with a catheter. There also is potential for leakage from the stoma (opening) that is made to take away urine. Infections related to urinary diversion may occur, as may infections related to the kidneys.
It is important for you to learn as much as you can about the urinary diversion method that you will use, and how to manage changes to your body. Before you leave the hospital, your healthcare providers will ensure that you get the education you need so you can manage your new way of life.
- Hormonal changes: For females who are not yet menopausal, you may have hot flashes after your ovaries are removed.
- Reproductive health: When the prostate is removed, a man can no longer father a child. Also, a man may be unable to have sex after surgery. When the uterus is removed, a woman can no longer get pregnant. If the surgeon removes part of a woman's vagina, then sex may be difficult.
- Sexual dysfunction: In reality, bladder cancer surgery is likely to affect your sex life. If you have a partner, you may be worried about maintaining sexual intimacy and your relationship. It may help you and your partner to talk about your feelings. You can find other ways to be intimate after you had treatment.
If you do not have a partner, you may want to explore how to manage your dating life after bladder cancer surgery. Either way, you (and your partner) may benefit from the advice of a counselor who specializes in discussing sexual issues.
Your healthcare provider may be able to refer you to medical professionals and counselors who specialize in sexual issues after cancer treatment. You can also find a certified sex therapist near you on the website of the American Association of Sexuality Educators, Counselors and Therapists.
- Managing Pain: You may have pain or discomfort for the first few days following bladder surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control. Refer to the Pain Management Fact Sheet
Remember that each person is different and each body may respond differently to therapy. It is important that you take care of yourself and remain in contact with your healthcare provider. Try to adopt healthy lifestyle habits including exercise, a well-balanced diet and no smoking. Your healthcare provider also may recommend a cancer support group or individual counseling.