{"id":2135,"date":"2021-01-01T08:00:00","date_gmt":"2021-01-01T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=2135"},"modified":"2026-08-30T03:14:05","modified_gmt":"2026-08-29T20:14:05","slug":"%eb%b0%a9%ea%b4%91%ec%95%94-%ec%97%ac%ec%a0%84%ed%9e%88-%ec%9e%ac%eb%b0%9c","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/ko\/2021\/01\/01\/bladder-cancer-still-recur\/","title":{"rendered":"Why Bladder Cancer Comes Back After a Complete Resection"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Best Urologist working in Chonburi and Cambodia\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=12%2C12&amp;ssl=1 12w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=600%2C600&amp;ssl=1 600w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=400%2C400&amp;ssl=1 400w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=200%2C200&amp;ssl=1 200w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:75%\">\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/drsoaraweeurology.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Soarawee Weerasopone, Urologist<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:+66880221445\" target=\"_blank\" rel=\"noreferrer noopener\">Samitivej Sriracha Hospital \u2014 Urology department: <strong>088-022-1445<\/strong><\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link has-background-background-color has-text-color has-background has-link-color has-small-font-size has-custom-font-size wp-element-button\" href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" style=\"color:#1b4965\" target=\"_blank\" rel=\"noreferrer noopener\">Book a Consultation<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<ul class=\"wp-block-social-links aligncenter has-normal-icon-size is-style-default 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C7.947,6.93,8.004,7.642,7.52,7.699c0,0-0.487,0.057-1.029,0.085l3.274,9.739l1.968-5.901l-1.401-3.838 C9.848,7.756,9.389,7.699,9.389,7.699C8.904,7.67,8.961,6.93,9.446,6.958c0,0,1.484,0.114,2.368,0.114 c0.94,0,2.397-0.114,2.397-0.114c0.485-0.028,0.542,0.684,0.057,0.741c0,0-0.488,0.057-1.029,0.085l3.249,9.665l0.897-2.996 C17.841,13.284,18.069,12.316,18.069,11.546z M19.889,7.686c0.039,0.286,0.06,0.593,0.06,0.924c0,0.912-0.171,1.938-0.684,3.22 l-2.746,7.94c2.673-1.558,4.47-4.454,4.47-7.771C20.991,10.436,20.591,8.967,19.889,7.686z M12,22C6.486,22,2,17.514,2,12 C2,6.486,6.486,2,12,2c5.514,0,10,4.486,10,10C22,17.514,17.514,22,12,22z\"><\/path><\/svg><span class=\"wp-block-social-link-label screen-reader-text\">\uc6cc\ub4dc\ud504\ub808\uc2a4<\/span><\/a><\/li>\n\n<li class=\"wp-social-link wp-social-link-linkedin wp-block-social-link\"><a href=\"https:\/\/www.linkedin.com\/in\/soarawee-weerasopone\/\" class=\"wp-block-social-link-anchor\"><svg width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" 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2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Many patients come to my clinic with painless blood in the urine and leave with a diagnosis of <a href=\"https:\/\/drsoaraweeurology.com\/2020\/08\/21\/bladder-cancer-so-do-i\/\">bladder cancer<\/a>. After the tumour has been completely removed endoscopically, I always explain that regular cystoscopic checks will still be needed \u2014 and the question that follows is always the same: if you removed all of it, why do I need to keep coming back? This article answers that. It deals specifically with <strong>low-grade<\/strong> bladder cancer, meaning a tumour whose cells look relatively close to normal under the microscope, confirmed on the tissue diagnosis after surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One clarification before we go on, because these two words are constantly mixed up. <strong>Grade<\/strong> describes how abnormal the cells look; <strong>stage<\/strong> describes how deeply the tumour has grown into the bladder wall. They are separate questions and your pathology report answers both. Low grade generally means a lower likelihood of the disease becoming life-threatening, but it does not mean no risk at all, and it is not the same thing as saying the tumour was superficial. Ask which grade and which stage yours was, and write both down \u2014 everything about your follow-up plan follows from those two answers.<\/p>\n\n\n<script type=\"application\/ld+json\">\r\n{\r\n  \"@context\": \"https:\/\/schema.org\",\r\n  \"@type\": \"FAQPage\",\r\n  \"mainEntity\": [\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Why does bladder cancer come back after surgery?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Bladder cancer recurs for two main reasons. First, the entire bladder lining has been exposed to the same carcinogens (such as those from smoking or petroleum-related work) that originally caused the cancer, so any mucosal cell can potentially become cancerous in the future. Second, during endoscopic resection, microscopic tumor cells can detach and float in the bladder fluid, then implant in other areas of the bladder wall and grow again \u2014 a process called the seeding theory.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What is the recurrence rate of bladder cancer after surgery?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Based on published literature, bladder cancer recurrence rates range from 15% to 61% within the first year after surgery, and from 31% to 78% within five years. The actual recurrence rate varies between individuals depending on tumor grade, stage, and other risk factors.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What causes bladder cancer in the first place?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"The number one triggers for bladder cancer are smoking and working in petroleum-related occupations. Inhaled toxic carcinogens enter the bloodstream, are filtered by the kidneys, and are excreted in urine. These carcinogens then stay in contact with the bladder lining \u2014 the urine storage organ \u2014 for prolonged periods, potentially over decades, triggering normal bladder cells to become cancerous.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Why is regular bladder checkup necessary after bladder cancer surgery?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Because the entire bladder lining remains at risk and recurrence is common, regular endoscopic surveillance using flexible cystoscopy is essential. Early detection of recurrent tumors allows for prompt treatment and better outcomes. The surveillance program is a critical part of long-term bladder cancer management.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What is done to prevent tumor seeding after bladder cancer surgery?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Immediately after endoscopic tumor resection, the urologist flushes the bladder with a medical agent designed to kill any floating tumor cells before they can implant and grow. This post-operative bladder irrigation is a standard step in reducing early recurrence from the seeding effect.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What is low-grade bladder cancer?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Low-grade bladder cancer refers to a tumor with a low chance of becoming life-threatening. The grade is determined from the tissue sample obtained during endoscopic surgery. While low-grade bladder cancer is less aggressive, it still has a significant recurrence rate and requires regular surveillance cystoscopy.\"\r\n      }\r\n    }\r\n  ]\r\n}\r\n<\/script>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"712\" height=\"304\" data-attachment-id=\"2142\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/2021\/01\/01\/bladder-cancer-still-recur\/flexible-cystoscopy\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/flexible-cystoscopy.jpg?fit=712%2C304&amp;ssl=1\" data-orig-size=\"712,304\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Flexible cystoscopy is the tool for surveillance bladder tumor recurrence Ref : www.ccmurology.com\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Flexible cystoscopy is the tool for surveillance bladder tumor recurrence Ref : www.ccmurology.com&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/flexible-cystoscopy.jpg?fit=712%2C304&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/flexible-cystoscopy.jpg?resize=712%2C304&#038;ssl=1\" alt=\"Flexible cystoscope used for surveillance of bladder tumour recurrence\" class=\"wp-image-2142\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/flexible-cystoscopy.jpg?w=712&amp;ssl=1 712w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/flexible-cystoscopy.jpg?resize=300%2C128&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/flexible-cystoscopy.jpg?resize=16%2C7&amp;ssl=1 16w\" sizes=\"(max-width: 712px) 100vw, 712px\" \/><figcaption class=\"wp-element-caption\">Flexible cystoscopy is the tool used to watch for recurrence. Image reference: <a href=\"http:\/\/www.ccmurology.com\" rel=\"nofollow\">http:\/\/www.ccmurology.com<\/a><\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Reason 1: the whole bladder lining has been exposed<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The best-established risk factor for bladder cancer is smoking, which accounts for a large share of cases. The next is occupational exposure to certain industrial chemicals \u2014 the aromatic amines historically used in dye, rubber, leather, paint and some petroleum work. Others are recognised but less common: chronic bladder irritation or infection, previous pelvic radiotherapy, some chemotherapy drugs, and arsenic in drinking water. It is worth saying plainly that a good number of patients have none of these, so the absence of a risk factor never rules the diagnosis out, and having had one is not something to blame yourself for.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What these exposures share is the route by which they reach the bladder. Whether they are breathed in or absorbed through the skin, they enter the bloodstream, travel around the body, and are filtered out by the kidneys into the urine.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The urine then sits in the bladder \u2014 the storage organ \u2014 until the next time you pass water. That means the bladder lining has the longest contact time with those carcinogens of any organ in the urinary tract, repeated every day for decades. The consequence is that the exposure was never confined to the patch of lining where the tumour appeared: <strong>every cell of the bladder lining has had the same exposure, so any of them may become a tumour in the future.<\/strong> Removing all the visible tumour does not undo that history, which is why a new tumour can appear anywhere in the bladder later on.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Reason 2: tumour cell seeding<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">During endoscopic resection, tiny clusters of tumour cells are released and float in the bladder fluid, even after thorough irrigation. They behave like scattered seeds \u2014 drifting, settling on another part of the bladder lining, and growing there.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This one has a countermeasure. At the end of the operation the bladder can be filled with a chemotherapy solution that destroys those free-floating cells before they can implant, and for a low-risk tumour this single early instillation is recommended by guidelines and does measurably reduce recurrence <a href=\"https:\/\/doi.org\/10.1097\/JU.0000000000003846\" target=\"_blank\" rel=\"noreferrer noopener\">(AUA\/SUO guideline, 2024)<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is not given to everyone, though, and the reasons are good ones. It is deliberately withheld where the bladder wall may have been perforated during the resection, where the resection was unusually extensive, or where there is significant bleeding \u2014 in all three the drug could leak beyond the bladder and cause serious harm. It is also not given to anyone known to be allergic to the drug. So if you did not receive it, that is usually a considered decision rather than something overlooked, and it is a perfectly fair question to put to your surgeon.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"2143\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ko\/2021\/01\/01\/bladder-cancer-still-recur\/doctor-and-patient\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;3.6&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;X-T1&quot;,&quot;caption&quot;:&quot;Doctor and patient.&quot;,&quot;created_timestamp&quot;:&quot;1496241198&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;20.5&quot;,&quot;iso&quot;:&quot;500&quot;,&quot;shutter_speed&quot;:&quot;0.0055555555555556&quot;,&quot;title&quot;:&quot;Doctor and patient.&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Good mutual understanding between patients and doctors are very important for maximizing clinical outcome\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Good mutual understanding between patients and doctors are very important for maximizing clinical outcome&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A urologist explaining a bladder cancer surveillance plan to a patient\" class=\"wp-image-2143\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/12\/Counselling.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Shared understanding between patient and doctor is what makes a surveillance programme work.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">What the recurrence figures actually are<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Even with best practice, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16442208\/\">reported<\/a> recurrence rates are 15\u201361% within 1 year of surgery and 31\u201378% within 5 years. Those ranges come from pooled trial data covering the whole spread of non-muscle-invasive tumours, from the mildest to the most aggressive, which is why they are so wide \u2014 and it is the reason the range on its own is close to useless for any individual. Your own risk is estimated from the specific features of your tumour: how many there were, how large, whether this was a first tumour or a recurrence, the grade, the stage, and whether carcinoma in situ was present. Urologists use published risk tables to turn those features into a number, and a patient at the favourable end of the scale sits nowhere near a patient at the unfavourable end. It is a reasonable thing to ask your own urologist for.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Read those numbers the right way. A recurrence is not a sign that the operation failed or that anything went wrong \u2014 it is an expected feature of this disease, and it is exactly what the surveillance programme exists to catch. Detected early, a recurrent tumour is usually straightforward to deal with. That is why keeping the cystoscopy appointments matters more than almost anything else you can do after the surgery.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">What to report between appointments<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Surveillance is a schedule, but it is not the only safety net. Contact your urology team, rather than waiting for the next appointment, if you notice:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Blood in the urine<\/strong>, even a single episode, even if it is painless and settles on its own \u2014 this is how most bladder tumours announced themselves in the first place<\/li>\n\n\n\n<li><strong>New urinary urgency, frequency or burning that does not settle<\/strong>, particularly if urine tests keep coming back clear \u2014 persistent irritative symptoms without infection can be the way carcinoma in situ presents<\/li>\n\n\n\n<li><strong>Flank or pelvic pain, or unexplained weight loss<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">And some things need the same day rather than an appointment: <strong>being unable to pass urine, heavy bleeding with clots, or fever with rigors. Go to an emergency department \u2014 in Thailand you can call 1669.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">The one thing that is in your own hands<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If you smoke, stopping is the most useful thing you can do after the operation. I want to be accurate about why, because this is a place where well-meant advice is often overstated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is well established is that people who smoke have more recurrences and more progression than people who do not <a href=\"https:\/\/doi.org\/10.1007\/s00432-022-04464-6\" target=\"_blank\" rel=\"noreferrer noopener\">(\u015alusarczyk et al., 2023)<\/a>. What is less settled is whether stopping <em>after<\/em> the diagnosis changes your own outcome. Several studies following patients over time suggest that those who quit do better <a href=\"https:\/\/doi.org\/10.1016\/j.eururo.2012.08.025\" target=\"_blank\" rel=\"noreferrer noopener\">(Rink et al., 2013)<\/a>. But the one study that checked smoking with a blood test rather than relying on what people reported found no difference in recurrence <a href=\"https:\/\/doi.org\/10.1097\/JU.0000000000002449\" target=\"_blank\" rel=\"noreferrer noopener\">(Furberg et al., 2022)<\/a>, and a more recent study following patients forward concluded the picture remains unclear <a href=\"https:\/\/doi.org\/10.1002\/ijc.35250\" target=\"_blank\" rel=\"noreferrer noopener\">(Kiebach et al., 2025)<\/a>. So the honest summary is that a benefit is likely but has not been proven.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That uncertainty is not a reason to shrug, and guidelines do not treat it as one \u2014 stopping smoking is explicitly recommended as part of the initial care of anyone diagnosed with bladder cancer. The reasons stand up regardless of how the recurrence question is eventually settled: continued smoking keeps delivering carcinogens to a bladder lining that has already shown what it can do, it worsens outcomes if further surgery is ever needed, and it affects heart and lung health at exactly the point in life when those matter most. It is a hard thing to be told after a cancer diagnosis, and it is still worth saying. If you want help rather than instruction, ask \u2014 structured support works far better than willpower alone.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Q1: If the surgeon removed all the tumour, why can bladder cancer still come back?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">For two reasons. First, the carcinogens that caused the tumour reach the bladder in the urine and are held in contact with the entire bladder lining for years, so every cell of that lining shares the same risk \u2014 not only the area where the first tumour grew. Second, resection releases small clusters of tumour cells into the bladder fluid, which can settle elsewhere in the bladder and grow. Complete removal of the visible tumour addresses what can be seen, not the underlying exposure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q2: How often does bladder cancer recur?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Published pooled data report recurrence in 15\u201361% of patients within 1 year of resection, and 31\u201378% within 5 years. Those ranges span the whole spectrum of non-muscle-invasive disease, which is why they are so wide and why the range alone tells an individual patient very little. Your own estimate depends on the number and size of tumours, whether this was a first presentation or a recurrence, the grade and stage, and whether carcinoma in situ was present; urologists use published risk tables to work it out. A recurrence does not mean the original surgery was inadequate.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q3: What is the difference between grade and stage?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Grade describes how abnormal the tumour cells look under the microscope; stage describes how deeply the tumour has grown into the bladder wall. They are separate and your pathology report gives both. Low grade generally carries a lower likelihood of the disease becoming life-threatening, but it is not the same as saying the tumour was superficial, and it does not mean surveillance can be relaxed. Ask for both your grade and your stage and keep a note of them, because the entire follow-up plan is built from those two answers.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q4: Why do I need repeated cystoscopy after bladder tumour surgery?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Because recurrence is common and usually causes no symptoms at first. Flexible cystoscopy allows a recurrent tumour to be found while it is still small and superficial, when treatment is simpler and outcomes are better. Surveillance is not a sign that something went wrong \u2014 it is the standard of care for anyone who has had a bladder tumour removed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q5: Should I report new blood in the urine between cystoscopy appointments?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes. Anyone with a history of bladder tumour who notices blood in the urine should contact their urologist rather than waiting for the next scheduled appointment, even if the bleeding is painless and settles on its own. Painless bleeding was how most bladder tumours announced themselves in the first place. Persistent urgency, frequency or burning without an infection on testing is also worth reporting. Heavy bleeding with clots, an inability to pass urine, or fever with rigors needs same-day emergency assessment rather than a routine appointment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q6: Why was I not given chemotherapy into the bladder after my operation?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A single instillation of chemotherapy soon after resection is recommended for low-risk tumours and reduces recurrence, but it is deliberately withheld in several situations \u2014 where the bladder may have been perforated during resection, where the resection was extensive, or where there is significant bleeding, because the drug can then leak beyond the bladder and cause serious harm. It is also not given to anyone with a known allergy to the drug. Not receiving it is therefore often a considered decision rather than an omission, and it is a fair question to ask your surgeon.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q7: Will stopping smoking reduce my risk of recurrence?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Probably, though it is fair to say the evidence is not as settled as you might expect. People who smoke clearly have more recurrences and more progression than people who do not. Whether quitting after diagnosis changes your own outcome is less certain: several follow-up studies suggest quitters do better, but a study that verified smoking with a blood test found no difference, and a recent prospective study concluded the question is still open. Guidelines nonetheless recommend stopping explicitly, and the reasons hold either way \u2014 continued smoking keeps delivering carcinogens to a bladder lining that has already produced one tumour, and it affects your outcome from any future surgery as well as your heart and lungs. Structured support works considerably better than willpower alone, so ask for it rather than trying to manage on your own.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q8: Can I discuss bladder cancer follow-up by video consultation?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, for reviewing results and planning. Bangkok Hospital Headquarters offers a Telemedicine service, arranged in advance by email to the Urology department at bhquro@bdms.co.th, and it is a practical way to go through a pathology report, understand your grade and stage, and agree a surveillance schedule \u2014 particularly for patients treated elsewhere or living abroad. Cystoscopy itself is a procedure and must be done in person. Samitivej Sriracha is in-person only, booked through the Urology department line 088-022-1445.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you have a history of bladder cancer and need ongoing surveillance or flexible cystoscopy follow-up, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Book a Consultation<\/a>. Appointments at Samitivej Sriracha Hospital can be arranged by calling the Urology department on <a href=\"tel:0880221445\">088-022-1445<\/a>. Questions about the cost of surveillance or surgery should go to the hospital directly \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sylvester RJ et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16442208\/\" target=\"_blank\" rel=\"noreferrer noopener\">PubMed 16442208<\/a><\/li>\n\n\n\n<li>Holzbeierlein JM et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA\/SUO guideline, 2024 amendment. <em>J Urol<\/em>. 2024. <a href=\"https:\/\/doi.org\/10.1097\/JU.0000000000003846\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1097\/JU.0000000000003846<\/a><\/li>\n\n\n\n<li>\u015alusarczyk A et al. The impact of smoking on recurrence and progression of non-muscle invasive bladder cancer: systematic review and meta-analysis. <em>J Cancer Res Clin Oncol<\/em>. 2023. <a href=\"https:\/\/doi.org\/10.1007\/s00432-022-04464-6\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1007\/s00432-022-04464-6<\/a><\/li>\n\n\n\n<li>Rink M et al. Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. <em>Eur Urol<\/em>. 2013. <a href=\"https:\/\/doi.org\/10.1016\/j.eururo.2012.08.025\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1016\/j.eururo.2012.08.025<\/a><\/li>\n\n\n\n<li>Furberg H et al. Association of biochemically verified post-diagnosis smoking and non-muscle-invasive bladder cancer recurrence risk. <em>J Urol<\/em>. 2022. <a href=\"https:\/\/doi.org\/10.1097\/JU.0000000000002449\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1097\/JU.0000000000002449<\/a><\/li>\n\n\n\n<li>Kiebach J et al. Smoking behaviour and the risks of tumour recurrence and progression in patients with non-muscle-invasive bladder cancer. <em>Int J Cancer<\/em>. 2025. <a href=\"https:\/\/doi.org\/10.1002\/ijc.35250\" target=\"_blank\" rel=\"noreferrer noopener\">doi:10.1002\/ijc.35250<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice, and it cannot substitute for your own pathology report and the surveillance plan agreed with your own team. No medical advice, diagnosis or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting any medical treatment. In an emergency, attend the nearest emergency department \u2014 in Thailand the emergency number is 1669.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/01\/bladder-cancer-still-recur\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/01\/bladder-cancer-still-recur\/\",\n      \"name\": \"Why Bladder Cancer Comes Back After a Complete Resection\",\n      \"description\": \"Why bladder cancer recurs even after every visible tumour is removed: the whole bladder lining shares the same carcinogen exposure, and resection can seed tumour cells. 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Smokers have higher recurrence and progression rates than non-smokers. Whether cessation after diagnosis alters an individual's outcome is less certain: several retrospective cohorts favour quitters, but a biochemically verified study found no association and a recent prospective cohort concluded the question remains open. Guidelines nonetheless recommend actively promoting cessation at diagnosis\"},\n        {\"@type\": \"MedicalRiskFactor\", \"name\": \"Occupational exposure to aromatic amines used historically in dye, rubber, leather, paint and some petroleum work\"},\n        {\"@type\": \"MedicalRiskFactor\", \"name\": \"Chronic bladder irritation or infection, previous pelvic radiotherapy, certain chemotherapy agents, and arsenic in drinking water\"},\n        {\"@type\": \"MedicalRiskFactor\", \"name\": \"Many patients have no identifiable risk factor, so absence of exposure does not exclude the diagnosis\"}\n      ],\n      \"typicalTest\": {\n        \"@type\": \"MedicalTest\",\n        \"name\": \"Surveillance flexible cystoscopy\",\n        \"description\": \"Repeated cystoscopy after resection, because recurrence usually causes no symptoms at first. It allows a recurrent tumour to be found while still small and superficial, when treatment is simpler. Between scheduled appointments, new visible blood in the urine or persistent irritative symptoms without infection should be reported rather than deferred.\"\n      },\n      \"possibleTreatment\": [\n        {\n          \"@type\": \"MedicalProcedure\",\n          \"name\": \"Transurethral endoscopic resection of bladder tumour\",\n          \"description\": \"Complete removal of the visible tumour. It addresses what can be seen, not the underlying field exposure of the bladder lining.\"\n        },\n        {\n          \"@type\": \"MedicalTherapy\",\n          \"name\": \"Immediate single post-operative intravesical chemotherapy instillation\",\n          \"description\": \"Instilled soon after resection to destroy free-floating tumour cells before they implant elsewhere in the bladder. Recommended for low-risk tumours, where it reduces recurrence.\",\n          \"contraindication\": {\n            \"@type\": \"MedicalContraindication\",\n            \"description\": \"Withheld where bladder perforation is suspected or known, where the resection was extensive, or where there is significant gross haematuria, because extravasation of the drug beyond the bladder can cause serious harm; also withheld in known allergy to the agent. Separately, it is not indicated in patients at high recurrence risk, where it is ineffective rather than unsafe.\"\n          }\n        }\n      ]\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/01\/bladder-cancer-still-recur\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/01\/01\/bladder-cancer-still-recur\/#webpage\" },\n      \"mainEntity\": [\n        {\"@type\": \"Question\", \"name\": \"If the surgeon removed all the tumour, why can bladder cancer still come back?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"For two reasons. The carcinogens that caused the tumour reach the bladder in the urine and stay in contact with the entire bladder lining for years, so every cell of that lining shares the same risk, not only the area where the first tumour grew. And resection releases small clusters of tumour cells into the bladder fluid, which can settle elsewhere and grow. Complete removal addresses what can be seen, not the underlying exposure.\"}},\n        {\"@type\": \"Question\", \"name\": \"How often does bladder cancer recur?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Published pooled data report recurrence in 15-61% of patients within 1 year of resection and 31-78% within 5 years. Those ranges span the whole spectrum of non-muscle-invasive disease, which is why they are so wide and why the range alone tells an individual patient very little. Individual risk depends on the number and size of tumours, whether this was a first presentation or a recurrence, the grade and stage, and whether carcinoma in situ was present, and is estimated using published risk tables. A recurrence does not mean the original surgery was inadequate.\"}},\n        {\"@type\": \"Question\", \"name\": \"What is the difference between grade and stage?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Grade describes how abnormal the tumour cells look under the microscope; stage describes how deeply the tumour has grown into the bladder wall. They are separate and the pathology report gives both. Low grade generally carries a lower likelihood of the disease becoming life-threatening, but it is not the same as saying the tumour was superficial, and it does not mean surveillance can be relaxed. The entire follow-up plan is built from those two answers.\"}},\n        {\"@type\": \"Question\", \"name\": \"Why do I need repeated cystoscopy after bladder tumour surgery?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Because recurrence is common and usually causes no symptoms at first. Flexible cystoscopy allows a recurrent tumour to be found while it is still small and superficial, when treatment is simpler and outcomes are better. Surveillance is the standard of care after any bladder tumour removal.\"}},\n        {\"@type\": \"Question\", \"name\": \"Should I report new blood in the urine between cystoscopy appointments?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Yes. Anyone with a history of bladder tumour who notices blood in the urine should contact their urologist rather than waiting for the next scheduled appointment, even if the bleeding is painless and settles on its own. Painless bleeding was how most bladder tumours announced themselves in the first place. Persistent urgency, frequency or burning without an infection on testing is also worth reporting. Heavy bleeding with clots, inability to pass urine, or fever with rigors needs same-day emergency assessment.\"}},\n        {\"@type\": \"Question\", \"name\": \"Why was I not given chemotherapy into the bladder after my operation?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"A single instillation of chemotherapy soon after resection is recommended for low-risk tumours and reduces recurrence, but it is deliberately withheld in several situations: where the bladder may have been perforated during resection, where the resection was extensive, or where there is significant bleeding, because the drug can then leak beyond the bladder and cause serious harm. It is also not given to anyone with a known allergy to the drug. Not receiving it is therefore often a considered decision rather than an omission, and it is a fair question to ask the surgeon.\"}},\n        {\"@type\": \"Question\", \"name\": \"Will stopping smoking reduce my risk of recurrence?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Probably, though the evidence is less settled than many expect. People who smoke clearly have more recurrences and more progression than people who do not. Whether quitting after diagnosis changes an individual's outcome is less certain: several follow-up studies suggest quitters do better, but a study that verified smoking biochemically found no difference, and a recent prospective study concluded the question is still open. Guidelines nonetheless recommend cessation explicitly, and the reasons hold either way, since continued smoking keeps delivering carcinogens to a bladder lining that has already produced one tumour and affects outcomes from any future surgery as well as heart and lung health. Structured support works considerably better than willpower alone.\"}},\n        {\"@type\": \"Question\", \"name\": \"Can I discuss bladder cancer follow-up by video consultation?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Yes, for reviewing results and planning. Bangkok Hospital Headquarters offers a Telemedicine service, arranged in advance by email to the Urology department at bhquro@bdms.co.th, and it is a practical way to go through a pathology report, understand grade and stage, and agree a surveillance schedule, particularly for patients treated elsewhere or living abroad. Cystoscopy itself is a procedure and must be done in person. Samitivej Sriracha is in-person only, booked through the Urology department line 088-022-1445.\"}}\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>If the surgeon removed every visible tumour, why does the bladder still need checking for years afterwards? Dr. Soarawee Weerasopone, urologist at Bangkok Hospital, explains the two reasons low-grade bladder cancer recurs \u2014 and why surveillance is not a sign that something went wrong.<\/p>","protected":false},"author":185281453,"featured_media":10023,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Why bladder cancer recurs after complete endoscopic resection: field exposure of the whole bladder lining, tumour cell seeding, what the 15-61% and 31-78% figures really mean, grade versus stage, and what to report between cystoscopies. By Dr. Soarawee Weerasopone.","jetpack_seo_html_title":"Why Bladder Cancer Recurs After Resection | Dr. Soarawee","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1364],"tags":[1429,1428,1430],"class_list":["post-2135","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-oncology","tag-bladder-cancer","tag-bladder-tumor","tag-recurrent-bladder-tumor"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-yr","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/Bladder-Cancer.webp?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts\/2135","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/comments?post=2135"}],"version-history":[{"count":23,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts\/2135\/revisions"}],"predecessor-version":[{"id":11805,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/posts\/2135\/revisions\/11805"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/media\/10023"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/media?parent=2135"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/categories?post=2135"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/ko\/wp-json\/wp\/v2\/tags?post=2135"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}