Bladder Cancer and Renal Cancer

  • Bente Thoft JensenEmail author
  • Susanne Vahr Lauridsen
Part of the Principles of Specialty Nursing book series (PSN)


This chapter aims to summarize the current evidence base on pre- and postoperative nursing interventions in surgical uro-oncological care focusing on the core cancer continuum of care from diagnose to entering the survivorship phase. Enhanced recovery after surgery (ERAS) is a multimodal approach aiming to enhance physical, nutritional, and psychological recovery in anticipation of surgery, mitigate the burden of disease, facilitate the return of patient health status to baseline values, and decrease postoperative morbidity. This chapter will describe the significant role of evidence-based nursing care in bladder and renal cancer surgery within an ERAS context.


Muscle invasive bladder cancer Renal cancer Radical cystectomy Nephrectomy Prehabilitation Rehabilitation Enhanced recovery pathways Cancer care Survivorship 


  1. 1.
    Newman DK, Wyman JF, Welch VW. Core curriculum for urologic nursing. 1st ed. New Jersey: Anthony J Janetti Inc; 2017.Google Scholar
  2. 2.
    Witjes JA, Comperat E, Cowan NC. Guidelines on muscle-invasive and metastatic bladder cancer. 2013. Available at: Accessed Aug 2013.
  3. 3.
    Dansk Urologisk Cancer Gruppe (Blærecancer). DABLACA (Dansk Blærecancer Udvalg). 2016. Available at: Accessed 25 Sept 2016, 2017.
  4. 4.
    Jensen BT, Lauridsen SV, Jensen JB. Prehabilitation for major abdominal urologic oncology surgery. Curr Opin Urol. 2018;28(3):243–50.PubMedGoogle Scholar
  5. 5.
    Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.PubMedGoogle Scholar
  6. 6.
    Adejoro O, Alishahi A, Konety B. Association of comorbidity, age, and radical surgical therapy for prostate cancer, bladder cancer, and renal cell carcinoma. Urology. 2016;97:130–137.e1.PubMedGoogle Scholar
  7. 7.
    Capitanio U, Montorsi F. Renal cancer. Lancet. 2016;387(10021):894–906.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Sanfilippo KM, McTigue KM, Fidler CJ, Neaton JD, Chang Y, Fried LF, et al. Hypertension and obesity and the risk of kidney cancer in 2 large cohorts of US men and women. Hypertension. 2014;63(5):934–41.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.PubMedGoogle Scholar
  10. 10.
    Kehlet H, Joshi GP. Enhanced recovery after surgery: current controversies and concerns. Anesth Analg. 2017;125(6):2154–5.PubMedGoogle Scholar
  11. 11.
    Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.PubMedGoogle Scholar
  12. 12.
    Kehlet H. Enhanced recovery after surgery (ERAS): good for now, but what about the future? Can J Anaesth. 2015;62(2):99–104.PubMedGoogle Scholar
  13. 13.
    Carli F, Minnella EM. Preoperative functional assessment and optimization in surgical patient: changing the paradigm. Minerva Anestesiol. 2017;83(2):214–8.PubMedGoogle Scholar
  14. 14.
    Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS®) society recommendations. Clin Nutr. 2013;32(6):879–87.PubMedGoogle Scholar
  15. 15.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36. PMID: 12765673PubMedGoogle Scholar
  16. 16.
    Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937–47.PubMedGoogle Scholar
  17. 17.
    Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery. 2016;160(5):1189–201.PubMedGoogle Scholar
  18. 18.
    Wilson RJ, Davies S, Yates D, Redman J, Stone M. Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth. 2010;105(3):297–303.PubMedGoogle Scholar
  19. 19.
    Carli F, Gillis C, Scheede-Bergdahl C. Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncol. 2017;56(2):128–33.PubMedGoogle Scholar
  20. 20.
    Tolchard S, Angell J, Pyke M, Lewis S, Dodds N, Darweish A, et al. Cardiopulmonary reserve as determined by cardiopulmonary exercise testing correlates with length of stay and predicts complications after radical cystectomy. BJU Int. 2015;115(4):554–61.PubMedGoogle Scholar
  21. 21.
    Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, et al. Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am. 2017;28(1):49–64.PubMedGoogle Scholar
  22. 22.
    Silver JK. Integrating rehabilitation into the cancer care continuum. PM R. 2017;9(9S2):S291–6.PubMedGoogle Scholar
  23. 23.
    Jensen BT, Dalbagni G, Jensen JB, Retinger C, Bowker M, Love N. Implementing a multimodal prehabilitation program in a high-volume Bladder Cancer Center. 2017. Available at: Accessed 21 Nov 2017.
  24. 24.
    Pang KH, Groves R, Venugopal S, Noon AP, Catto JWF. Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy. Eur Urol 2017;pii: S0302-2838(17)30660-7. [Epub ahead of print].Google Scholar
  25. 25.
    Jensen BT, Laustsen S, Jensen JB, Borre M, Petersen AK. Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways-secondary results from a randomized controlled trial. Support Care Cancer. 2016;24(8):3325–31.PubMedGoogle Scholar
  26. 26.
    Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial. Scand J Urol. 2015;49(2):133–41.PubMedGoogle Scholar
  27. 27.
    Banerjee S, Manley K, Shaw B, Lewis L, Cucato G, Mills R, Rochester M, Clark A, Saxton JM. Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy: a feasibility randomised controlled trial. Support Care Cancer. 2018;26(5):1515–23. Epub 2017 Nov 27. PMID: 29181804PubMedGoogle Scholar
  28. 28.
    van Rooijen S, Carli F, Dalton SO, Johansen C, Dieleman J, Roumen R, et al. Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation. Acta Oncol. 2017;56(2):329–34.PubMedGoogle Scholar
  29. 29.
    Minnella EM, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol. 2017;56(2):295–300.PubMedGoogle Scholar
  30. 30.
    Reid KF, Fielding RA. Skeletal muscle power: a critical determinant of physical functioning in older adults. Exerc Sport Sci Rev. 2012;40(1):4–12.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Bean JF, Kiely DK, LaRose S, Goldstein R, Frontera WR, Leveille SG. Are changes in leg power responsible for clinically meaningful improvements in mobility in older adults? J Am Geriatr Soc. 2010;58(12):2363–8.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Jensen BT, Jensen JB, Laustsen S, Petersen AK, Sondergaard I, Borre M. Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial. J Multidiscip Healthc. 2014;7:301–11.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Memorial Sloan Kettering Cancer Center, Department of Integrative Medicine. General Exercises Level-2. 2016. Available at: 2015.
  34. 34.
    American Thoracic Society. ATS statement: guidelines for the six-minute walk test. ATS Committee Proficiency Standards for Clinical Pulmonary Function Lab. Am J Respir Crit Care Med. 2002;166(1):111–7.Google Scholar
  35. 35.
    Gillis C, Loiselle SE, Fiore JF Jr, Awasthi R, Wykes L, Liberman AS, et al. Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial. J Acad Nutr Diet. 2016;116(5):802–12.PubMedGoogle Scholar
  36. 36.
    Kabata P, Jastrzebski T, Kakol M, Krol K, Bobowicz M, Kosowska A, et al. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition-prospective randomized controlled trial. Support Care Cancer. 2015;23(2):365–70.PubMedGoogle Scholar
  37. 37.
    Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542–59.Google Scholar
  38. 38.
    Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28(4):378–86.PubMedGoogle Scholar
  39. 39.
    Spies CD, von Dossow V, Eggers V, Jetschmann G, El-Hilali R, Egert J, et al. Altered cell-mediated immunity and increased postoperative infection rate in long-term alcoholic patients. Anesthesiology. 2004;100(5):1088–100.PubMedGoogle Scholar
  40. 40.
    Tonnesen H. Alcohol abuse and postoperative morbidity. Dan Med Bull. 2003;50(2):139–60.PubMedGoogle Scholar
  41. 41.
    Eliasen M, Gronkjaer M, Skov-Ettrup LS, Mikkelsen SS, Becker U, Tolstrup JS, et al. Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2013;258(6):930–42.PubMedGoogle Scholar
  42. 42.
    Crivelli JJ, Xylinas E, Kluth LA, Rieken M, Rink M, Shariat SF. Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature. Eur Urol. 2014;65(4):742–54.PubMedGoogle Scholar
  43. 43.
    Hou L, Hong X, Dai M, Chen P, Zhao H, Wei Q, et al. Association of smoking status with prognosis in bladder cancer: a meta-analysis. Oncotarget. 2017;8(1):1278–89.PubMedGoogle Scholar
  44. 44.
    Hemal S, Krane LS, Richards KA, Liss M, Kader AK, Davis RL 3rd. Risk factors for infectious readmissions following radical cystectomy: results from a prospective multicenter dataset. Ther Adv Urol. 2016;8(3):167–74.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Liss MA, White M, Natarajan L, Parsons JK. Exercise decreases and smoking increases bladder cancer mortality. Clin Genitourin Cancer. 2017;15(3):391–5.PubMedGoogle Scholar
  46. 46.
    Rink M, Zabor EC, Furberg H, Xylinas E, Ehdaie B, Novara G, et al. Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy. Eur Urol. 2013;64(3):456–64.PubMedGoogle Scholar
  47. 47.
    Rink M, Crivelli JJ, Shariat SF, Chun FK, Messing EM, Soloway MS. Smoking and bladder cancer: a systematic review of risk and outcomes. Eur Urol Focus. 2015;1(1):17–27.PubMedGoogle Scholar
  48. 48.
    Lee C, Kim KH, You D, Jeong IG, Hong B, Hong JH, et al. Smoking and survival after radical cystectomy for bladder cancer. Urology. 2012;80(6):1307–12.PubMedGoogle Scholar
  49. 49.
    Gronkjaer M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52–71.PubMedGoogle Scholar
  50. 50.
    Oppedal K, Moller AM, Pedersen B, Tonnesen H. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev. 2012;11(7):CD008343.Google Scholar
  51. 51.
    Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;27(3):CD002294.Google Scholar
  52. 52.
    Lauridsen SV, Thomsen T, Thind P, Tonnesen H. STOP smoking and alcohol drinking before operation for bladder cancer (the STOP-OP study), perioperative smoking and alcohol cessation intervention in relation to radical cystectomy: study protocol for a randomised controlled trial. Trials. 2017;18(1):329. Scholar
  53. 53.
    Warner DO, Patten CA, Ames SC, Offord K, Schroeder D. Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery. Anesthesiology. 2004;100(5):1125–37.PubMedGoogle Scholar
  54. 54.
    Lauridsen SV, Thomsen T, Kaldan G, Lydom LN, Tonnesen H. Smoking and alcohol cessation intervention in relation to radical cystectomy: a qualitative study of cancer patients’ experiences. BMC Cancer. 2017;17(1):793. Scholar
  55. 55.
    Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Lawson PJ, Flocke SA, Casucci B. Development of an instrument to document the 5A’s for smoking cessation. Am J Prev Med. 2009;37(3):248–54.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Kristensen SA, Laustsen S, Kiesbye B, Jensen BT. The Urostomy Education Scale: a reliable and valid tool to evaluate urostomy self-care skills among cystectomy patients. J Wound Ostomy Continence Nurs. 2013;40(6):611–7.PubMedGoogle Scholar
  58. 58.
    O’Connor G. Teaching stoma-management skills: the importance of self-care. Br J Nurs. 2005;14(6):320–4.PubMedGoogle Scholar
  59. 59.
    Danielsen AK, Christensen BM, Mortensen J, Voergaard LL, Herlufsen P, Balleby L. Establishment of a regional Danish database for patients with a stoma. Color Dis. 2015;17(1):O27–33.Google Scholar
  60. 60.
    Vujnovich A. Pre and post-operative assessment of patients with a stoma. Nurs Stand. 2008;22(19):50–6. quiz 58.PubMedGoogle Scholar
  61. 61.
    Metcalf C. Stoma care: empowering patients through teaching practical skills. Br J Nurs. 1999;8(9):593–600.PubMedGoogle Scholar
  62. 62.
    Tal R, Cohen MM, Yossepowitch O, Golan S, Regev S, Zertzer S, et al. An ileal conduit – who takes care of the stoma? J Urol. 2012;187(5):1707–12.PubMedGoogle Scholar
  63. 63.
    Mohamed NE, Chaoprang Herrera P, Hudson S, Revenson TA, Lee CT, Quale DZ, et al. Muscle invasive bladder cancer: examining survivor burden and unmet needs. J Urol. 2014;191(1):48–53.PubMedGoogle Scholar
  64. 64.
    Salvadalena G, Hendren S, McKenna L, Muldoon R, Netsch D, Paquette I, et al. WOCN society and ASCRS position statement on preoperative stoma site marking for patients undergoing colostomy or ileostomy surgery. J Wound Ostomy Continence Nurs. 2015;42(3):249–52.PubMedGoogle Scholar
  65. 65.
    McKenna LS, Taggart E, Stoelting J, Kirkbride G, Forbes GB. The impact of preoperative stoma marking on health-related quality of life: a comparison Cohort study. J Wound Ostomy Continence Nurs. 2016;43(1):57–61.PubMedGoogle Scholar
  66. 66.
    Kozell K, Frecea M, Thomas JT. Preoperative ostomy education and stoma site marking. J Wound Ostomy Continence Nurs. 2014;41(3):206–7.PubMedGoogle Scholar
  67. 67.
    Danielsen AK, Rosenberg J. Health related quality of life may increase when patients with a stoma attend patient education – a case-control study. PLoS One. 2014;9(3):e90354.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Jensen BT, Kiesbye B, Soendergaard I, Jensen JB, Kristensen SA. Efficacy of preoperative uro-stoma education on self-efficacy after radical cystectomy; secondary outcome of a prospective randomized controlled trial. Eur J Oncol Nurs. 2017;28:41–6.PubMedGoogle Scholar
  69. 69.
    Kristensen SA, Jensen BT. Testing inter-rater reliability of the Urostomy Education Scale. Eur J Oncol Nurs. 2016;20:17–23.PubMedGoogle Scholar
  70. 70.
    Jensen BT, de Blok W, Kiesbye B, Kristensen SA. Validation of the urostomy education scale: the European experience. Urol Nurs. 2013;33(5):219–29.PubMedGoogle Scholar
  71. 71.
    Lindau ST, Abramsohn EM, Baron SR, Florendo J, Haefner HK, Jhingran A, et al. Physical examination of the female cancer patient with sexual concerns: what oncologists and patients should expect from consultation with a specialist. CA Cancer J Clin. 2016;66(3):241–63.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Veskimae E, Neuzillet Y, Rouanne M, MacLennan S, Lam TBL, Yuan Y, et al. Systematic review of the oncological and functional outcomes of pelvic organ-preserving radical cystectomy (RC) compared with standard RC in women who undergo curative surgery and orthotopic neobladder substitution for bladder cancer. BJU Int. 2017;120(1):12–24.PubMedGoogle Scholar
  73. 73.
    Rosen RC. Assessment of sexual dysfunction in patients with benign prostatic hyperplasia. BJU Int. 2006;97(Suppl 2):29–33. discussion 44-5.PubMedGoogle Scholar
  74. 74.
    Zahran MH, Fahmy O, El-Hefnawy AS, Ali-El-Dein B. Female sexual dysfunction post radical cystectomy and urinary diversion. Climacteric. 2016;19(6):546–50.PubMedGoogle Scholar
  75. 75.
    Henningsohn L, Wijkstrom H, Steven K, Pedersen J, Ahlstrand C, Aus G, et al. Relative importance of sources of symptom-induced distress in urinary bladder cancer survivors. Eur Urol. 2003;43(6):651–62.PubMedGoogle Scholar
  76. 76.
    Mohamed NE, Pisipati S, Lee CT, Goltz HH, Latini DM, Gilbert FS, et al. Unmet informational and supportive care needs of patients following cystectomy for bladder cancer based on age, sex, and treatment choices. Urol Oncol. 2016;34(12):531.e7–531.e14.Google Scholar
  77. 77.
    Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, et al. Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol. 2015;22(13):4117–23.PubMedGoogle Scholar
  78. 78.
    Pozzar RA, Berry DL. Gender differences in bladder cancer treatment decision making. Oncol Nurs Forum. 2017;44(2):204–9.PubMedGoogle Scholar
  79. 79.
    Morgeli R, Scholtz K, Kurth J, Treskatsch S, Neuner B, Koch S, et al. Perioperative management of elderly patients with gastrointestinal malignancies: the contribution of anesthesia. Visc Med. 2017;33(4):267–74.PubMedPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Clinical MedicineAarhus University & Chair of Bladder Cancer SIG-Group, European Association of Urology NursesAarhusDenmark
  2. 2.Department of UrologyCopenhagen University Hospital & Chair of the European Association of Urology NursesCopenhagenDenmark

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