Evaluation, etiology, and management of gross hematuria following radical cystectomy and orthotopic neobladder.

OBJECTIVE: To assess the etiology, evaluation, and subsequent management of patients who developed gross hematuria following radical cystectomy (RC) and orthotopic neobladder (ONB) urinary diversion. METHODS: All patients who underwent RC and ONB between 2017 and 2021 and later developed gross hematuria necessitating cystoscopy were identified. Patient demographics, cystoscopy reports, cytology findings, and relevant imaging were reviewed to determine the etiology of hematuria, the subsequent management, and the ultimate outcome. Causes of hematuria were categorized as recurrence, inflammation/infection, anticoagulation-related, or undetermined. RESULTS: Twenty-one patients underwent cystoscopy for gross hematuria following RC and ONB during the study period. Most patients were male (n = 19, 90.5%), and the median age was 71 years (IQR: 67-75). Five (23.8%) patients had hematuria secondary to cancer recurrence-4 urethral and one upper tract recurrence. Other etiologies of hematuria included pouchitis (n = 5, 23.8%) and presumed anticoagulation-related bleeding (n = 2, 9.5%). In 9 (42.9%) patients, the etiology of hematuria remained undetermined despite comprehensive workup. Among the 5 patients whose hematuria was secondary to cancer recurrence, the median time from cystectomy to hematuria was 29 months (Interquartile range: 15-36). CONCLUSIONS: Up to a quarter of patients who present with gross hematuria following RC with ONB may have cancer recurrence. Consequently, a thorough evaluation is warranted in all patients.