Introduction

A three-week inpatient follow-up treatment (FT) in government-approved rehabilitation clinics is offered after radical cystectomy (RC) for bladder cancer (BC) for all patients in Germany. We investigated both the physical condition and expectations of the patients at the beginning of the FT as well as complications during the 3-week period and results thereafter.

Methods

81 patients from different urological departments who underwent RC for BC and an orthotopic neobladder reconstruction were included. Time from hospital discharge until beginning of FT, BMI, initial blood count, Karnovsky scale, antibiotics, antithrombotics and use of incontinence pads were assessed. Furthermore patients were asked for main complaints as well as expectations towards the three-week FT. Complications like metabolic acidosis and urinary tract infections during FT as well as medication, incontinence pad use and patients` complaints after FT were monitored.

Results

Median time between RC and discharge from the primary hospital to FT was 35 days (interquartile range [IQR] 25-41 days) and 13 days ([IQR] 4-16 days) respectively. The medical condition at the beginning of FT was good: mean Karnovsky 72% ([IQR] 70-88%), mean BMI 23.1 ([IQR] 20.9- 27.7), mean hemoglobin, creatinine and leukocytes in the normal range. The five most common complaints mentioned are general weakness (79%), incontinence (77%), pain (31%), fatigue (30%), and mental distress (43%). The three most important expectations towards FT were improvement of the general physical capacity (86%), followed by improvement of incontinence (81%) and reduction of mental distress (31%). During FT 25.9% of patients had a urinary tract infection requiring antibiotics and 8.6% had a symptomatic metabolic acidosis. Only 18.1% were under antithrombotic medication at the beginning of FT. Antibiotic use decreased from 19.8% to 17.3%. Incontinence pad use increased from 2.14 to 2.55 pads per day on average. At the end of FT, patients indicated improvement of incontinence, physical capacity and mental distress in 60.5%, 74.1% and 30.86%.

Conclusions

Compared to the pre- and perioperative management of BC, there is a scarcity of studies investigating FT of BC. A multitude of significantly different FT models have been implemented in different countries. Both from the economic as well as medical point of view high-quality FT must be strived for. Our study gives insights into the current state of FT in Germany and shows both benefits as well as unsolved challenges.

Funding

none