were analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTSThe median age of patients was 68 years with a mean (median) follow-up time of 35 (29) months. The 30, 60 and 90-day postoperative mortality rates were 1.3%, 2.6% and 3.2%, respectively. The 5-year overall, recurrencefree and cancer-specific survival was 57%, 48% and 67%, respectively, with a local recurrence rate of 6%. Pathological stage distribution was < pT2N0, n = 498 (23%); pT2N0, n = 365 (17%); pT3N0, n = 463 (21%); pT4N0, n = 170 (8%); and pTxN + , n = 507 (23%). Only 3.1% of patients received neoadjuvant chemotherapy and 19.4% received adjuvant chemotherapy. On multivariate analysis, lower pathological stage, negative surgical margins, receipt of adjuvant chemotherapy, performance of pelvic lymphadenectomy and an absence of smoking were associated with prolonged disease-specific and overall survival.

Increasing comorbidity was independently associated with an increased risk of 90-day mortality and early postoperative complications after radical cystectomy.

Study Type – Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Radical cystectomy with pelvic lymph node dissection is recognized as the standard of care for carcinoma invading bladder muscle and for refractory non‐muscle‐invasive bladder cancer. Owing to high recurrence and progression rates, a two‐pronged strict surveillance regimen, consisting of both functional and oncological follow‐up, has been advocated. It is also well recognized that more aggressive tumours with extravesical disease and node‐positive disease recur more frequently and have worse outcomes. This study adds to the scant body of literature available regarding surveillance strategies after radical cystectomy for bladder cancer. In the absence of any solid evidence supporting the role of strict surveillance regimens, this extensive examination of recurrence patterns in a large multi‐institutional project lends further support to the continued use of risk‐stratified follow‐up and emphasizes the need for earlier strict surveillance in patients with extravesical and node‐positive disease. OBJECTIVES To review our data on recurrence patterns after radical cystectomy (RC) for bladder cancer (BC). To establish appropriate surveillance protocols. PATIENTS AND METHODS We collected and pooled data from a database of 2287 patients who had undergone RC for BC between 1998 and 2008 in eight different Canadian academic centres. Of the 2287 patients, 1890 had complete recurrence information and form the basis of the present study. RESULTS A total of 825 patients (43.6%) developed recurrence. According to location, 48.6% of recurrent tumours were distant, 25.2% pelvic, 14.5% retroperitoneal and 11.8% to multiple regions such as pelvic and retroperitoneal or pelvic and distant. The median (range) time to recurrence for the entire population was 10.1 (1–192) months with 90 and 97% of all recurrences within 2 and 5 years of RC, respectively. According to stage, pTxN+ tumours were more likely to recur than ≥pT3N0 tumours and ≤pT2N0 tumours (5‐yr RFS 25% vs. 44% vs. 66% respectively, P < 0.001). Similarly, pTxN+ tumours had a shorter median time to recurrence (9 months, range 1–72 months) than ≥pT3N0 tumours (10 months, range 1–70 months) or ≤pT2N0 tumours (14 months, range 1–192 months, P < 0.001). CONCLUSIONS Differences in recurrence patterns after RC suggest the need for varied follow‐up protocols for each group. We propose a stage‐based protocol for surveillance of patients with BC treated with RC that captures most recurrences while limiting over‐investigation.

Increased comorbidity was independently associated with an increased risk of overall mortality and bladder cancer specific mortality after radical cystectomy.

The purpose of this review of clinical guidelines and best practices literature is to suggest prevention options and a treatment approach for intermittent catheter users that will minimize urinary tract infections (UTI). Recommendations are based both on evidence in the literature and an understanding of what is currently attainable within the Alberta context. This is done through collaboration between both major tertiary care centres (Edmonton and Calgary) and between various professionals who regularly encounter these patients, including nurses, physiatrists and urologists. Bladder management in the context of a spinal cord injuryA pervasive issue in most neurologic diseases (Parkinson's disease, multiple sclerosis, diabetes, stroke and spinal cord injury [SCI]) is bladder dysfunction (neurogenic bladder) or neurogenic lower urinary tract dysfunction (NLUTD). These dysfunctions result in symptoms of urgency, increased daytime and nighttime frequency, urinary retention, incontinence and urinary tract infection (UTI). Treatment involves non-invasive continence management through toileting, fluid management, containment products, medications and intermittent catheterization. UTIs have substantial negative physical and psychological effects and are a major burden on the health care system. Frequent UTI in the SCI population is defined clinically as 3 or more infections per year where both symptoms of infection and a positive urine culture are present. Despite the variety of treatment approaches to emptying the neurogenic bladder, UTI remains a complex and challenging clinical problem.Intermittent catheterization (IC) is recognized as the gold standard for treating voiding disorders associated with the neurogenic bladder.