Complications
Before starting treatment with an immune checkpoint inhibitor, counsel patients and carer on the symptoms of immune-related adverse effects.[186]
Immune checkpoint inhibitors are associated with a range of adverse effects that can affect any organ system. Common early adverse effects include rash, colitis, and pneumonitis. Later-onset adverse effects can include neurological events and hypophysitis.[186]
Patients receiving immunotherapy should be monitored closely for treatment-related toxicity and endocrine dysfunction. Guidelines for monitoring of patients and management of complications are available.[186][187]
Risk of urothelial carcinoma of the prostatic urethra is relatively low in low-risk disease that is controlled by intravesical therapy, but up to one quarter of high-risk patients will develop urothelial carcinoma of the prostate by 15 years when Bacillus Calmette-Guérin (BCG) maintenance is not given. Prostatic urethral urothelial carcinoma in these patients has a high (>40%) mortality even with aggressive treatment such as cystoprostatectomy.[90]
Upper tract (ureteral or renal pelvic) urothelial carcinoma can occur in low- or high-grade disease, but is dangerous in high-risk patients and requires monitoring of the upper tracts. As many as one quarter of high-risk patients will develop upper tract urothelial carcinoma by 15 years and mortality is high (>30%).[182] Most upper tract tumours are diagnosed by symptoms (haematuria, flank pain). Cytology surveillance detects only 7%, and imaging 29%.[183]
Tumour of the trigone, ureteral orifice, or ureter can obstruct and cause renal damage.
Tumours at the bladder neck can cause outlet obstruction. Bleeding from tumour or following tumour resection can cause clot retention.
Use of this content is subject to our disclaimer