Early cystoscopy improves NMIBC survival

By Agata Buczak

Undergoing cystoscopy within 6 months of transurethral resection of bladder tumors (TURBT) is associated with improved survival outcomes in patients with non–muscle-invasive bladder cancer (NMIBC), according to a nationwide Korean study involving 40,678 individuals.

Published in Investigative and Clinical Urology, the retrospective analysis used data from the National Health Insurance Service, which covers 99% of the South Korean population. Jeong-Soo Kim (Chung-Ang University, Seoul, Korea) and colleagues stratified patients by whether they received cystoscopy within 6 months of their initial TURBT: 28,738 patients did, while 11,940 did not.

Although recurrence was a significant 32% more frequent in the cystoscopy group, the authors suggest this may reflect earlier detection rather than poorer outcomes. Over a median follow-up of 15 years, patients who underwent cystoscopy within 6 months had a 30% lower risk of progression, a 38% lower risk of cancer-specific mortality, and a 42% lower risk of all-cause mortality compared with those who did not.

Subgroup analysis showed no difference in recurrence among patients who received Bacillus Calmette–Guérin (BCG) or underwent repeat TURBT, reinforcing that these factors should not delay the first cystoscopy.

To reduce survival bias, the study excluded patients who experienced recurrence, progression, or death within the first 6 months after TURBT. This methodological choice helped ensure that comparisons between groups were not skewed by early adverse events.

Despite its strengths, the study had limitations. The dataset did not include tumor characteristics or patient lifestyle factors, and individual clinicians determined cystoscopy timing. However, the use of inverse probability treatment weighting helped adjust for key confounders.

Of note, although guidelines recommend cystoscopy at around 3 months after TURBT, nearly 30% of patients in this cohort did not receive follow-up within 6 months. This gap may have implications for long-term outcomes, and the authors conclude: “Regular cystoscopy within 6 months was able to detect more bladder tumor recurrence.”

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