Outcomes of Bladder Preservation Following Treatment for Rhabdomyosarcoma

Genitourinary rhabdomyosarcoma (RMS) is a relatively uncommon pediatric urologic oncologic condition with significant implications for both short- and long-term bladder functions. It is important for both pediatric and adult urologists to be aware of the pathophysiology, treatment, and long-term prognosis of this tumor and its potential impact on bladder function in both pediatric and adult survivors.

Abnormalities in bladder function may arise secondary to surgical or medical management. Typical presenting complaints include lower urinary tract symptoms, which may be more common in pediatric RMS survivors than in survivors of other childhood cancers. Post-treatment evaluation of urinary function should include a baseline urodynamics study and an assessment of symptom severity and bother using validated, age-appropriate questionnaires. Upper tract monitoring should include renal/bladder ultrasound and serum creatinine. Hemorrhagic cystitis, which often develops acutely in patients receiving alkylating agents, may also present as a late effect. Lastly, urinary diversion may be required in patients with bladder/prostate (BP)-RMS either due to initial or delayed cystectomy or due to radiation-related loss of bladder function. Recent data suggest that diversion can maintain excellent quality of life in these patients.

Both BP-RMS and its treatments have the potential for profound impacts on long-term bladder function. Most BP-RMS patients will survive beyond their initial diagnosis and treatment, and it is therefore important for both pediatric and adult urologists to be aware of the pathophysiology, treatment, and long-term prognosis of this tumor and its potential impact on bladder function in both pediatric and adult survivors.