BAUS 2015

Introduction
EAU guidelines recommend urine cytology as part of surveillance following diagnosis of high-risk non-muscle-invasive bladder cancer (NMIBC). However, controversy remains regarding the diagnostic utility of urine cytology in this setting. We aimed to evaluate use of urine cytology as part of surveillance for NMIBC in our tertiary urology centre, and assess its impact on management.

Materials and methods
We retrospectively studied all NMIBC patients undergoing surveillance flexible cystoscopy over 3 months. Patients were risk stratified according to EAU guidelines. Use of urine cytology was assessed and compared with EAU guidance, focusing on high-risk patients.

Results
327 patients were eligible for inclusion. 151 classified as high-risk. Urine cytology was performed in 75 (49%) high-risk patients. Nine had abnormal cytology with normal upper tract imaging. Six of these patients underwent bladder biopsy, all of whom had abnormal cystoscopic findings. Recurrent NMIBC was confirmed in 4 cases.

Of high-risk patients without urine cytology, 19 underwent bladder biopsy due to abnormal cystoscopy, 14 of whom had confirmed recurrence. There were no high-risk patients with 'normal' cystoscopy who were biopsied based on abnormal urine cytology.

Conclusion
Urine cytology did not provide benefit in identifying NMIBC recurrences which would have otherwise been missed as all patients with recurrence had abnormal cystoscopy. Despite EAU guidelines, utility of urine cytology in high-risk NMIBC follow-up remains uncertain, which may account for our findings. We propose larger multi-centre studies to further investigate the benefit of performing urine cytology as part of surveillance in patients with previous high-risk NMIBC.