Follow-up Compliance among Post-transurethral Resection of Bladder Tumor Patients: A Retrospective Study at a Tertiary Care Center
Chirackal Hasan Haris, Pushpa Rajan Saju, Tony Thomas John, Rajiv Sajan Thomas, Amal Mohan, Manu Jose Chirayath, Ramkumar Aiyyappan, Prabhakaran Sheela Harsha, Jinesh Jayadevan, Sharoo Shaneej, Hari BalabhaskarAbstract
Background:
Bladder cancer is a common malignancy with significant recurrence and progression rates, necessitating strict adherence to post-transurethral resection of bladder tumor (TURBT) surveillance protocols. However, in many low- and middle-income settings, compliance remains suboptimal, contributing to delayed detection of recurrence and poorer outcomes.
Objectives:
This study aimed to evaluate real-world follow-up adherence among bladder cancer patients who underwent TURBT in 2022 at a high-volume tertiary care center in Southern India and to identify factors associated with lost to follow-up.
Materials and Methods:
A retrospective cohort study was conducted among 141 patients who underwent TURBT in 2022. Medical records and telephonic interviews were reviewed to collect demographic characteristics, tumor profile, follow-up details, reasons for noncompliance, and mortality outcomes. Compliance was assessed according to standard surveillance recommendations for nonmuscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) as per European Association of Urology and American Urological Association guidelines. Mortality data were analyzed based on biopsy findings and clinical documentation. Institutional ethics approval was obtained.
Results:
Of 141 patients, 110 (78%) had NMIBC and 31 (22%) had MIBC. Only 52 patients (36.9%) complied with scheduled follow-up visits. Major reasons for noncompliance included inability to contact the patient (23%), financial constraints (10%), lack of caregiver support (7%), fear of cystoscopy (6%), and travel-related challenges (4%), reflecting patterns reported globally. A total of 23 deaths (16.3%) were recorded, of which 20 were cancer-related. Among NMIBC patients, five deaths occurred—all follow-up defaulters—supporting evidence that irregular surveillance worsens outcomes. In the MIBC group, cancer-related mortality was substantial (65%).
Conclusion:
Follow-up compliance after TURBT remains critically low, with multiple socioeconomic, logistical, and psychological factors contributing to attrition. Noncompliance was associated with higher mortality, particularly in patients with high-grade disease. Strengthening patient counseling, improving communication systems, decentralizing surveillance services, and addressing financial and logistical barriers are essential to improving long-term outcomes in bladder cancer care.