Compliance with data registration for centres and surgeons performing RP is high in the present series. Most RPs were performed in high-case-volume centres and by high-case-volume surgeons, with the most common approaches being minimally invasive and specifically RAS. High-case-volume centres and surgeons reported higher rates of extended LND and training cases. Higher-case-volume surgeons reported lower pT2 PSM rates, whilst the most marked differences in transfusion rates and LOS were seen when ORP was compared to minimally invasive approaches. Caution must be applied when interpreting these differences on the basis of this being registry data - causality cannot be assumed.
To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation.
Patients and MethodsThis was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries.
Squamous cell carcinoma (SCC) arising from a suprapubic cystostomy tract is a rare complication of long-term suprapubic catheterization (SPC). A 53-year-old man with paraplegia secondary to spina bifida presented with a painful granulomatous lesion around his SPC site that was being treated with silver nitrate cauterization in the community. Consequently, he developed a sacral pressure sore due to reduced mobility from the pain. He also had increasing difficulties with defaecation secondary to his spina bifida. His sacral pressure sore was secondary to a cryptoglandular fistula with coccygeal osteomylelitis. Post-operative pathology revealed infiltrative SCC involving full thickness of the specimen from skin to the bladder wall with clear surgical margins. We describe the first case requiring a simultaneous suprapubic tract SCC excision and colostomy formation. We recommend early investigation of lesions arising from a long-term suprapubic tract especially in patients with spinal cord injuries or congenital defects.
Bladder cancer carries high mortality and a delay in treatment after diagnosis has been shown to affect survival in patients with muscle invasive disease. Less is known about the incidence and impact of diagnostic delay itself. The purpose of this study is to investigate patterns of healthcare utilization in the two years leading up to the diagnosis of bladder cancer. During this period, we hypothesized to find an increase in healthcare utilization for diagnoses symptomatically similar to bladder cancer METHODS: We conducted a retrospective case study using the Truven Health Analytics Commercial Claims and Encounters Database from 2001-2017. First, we identified index visits where a diagnosis of bladder cancer first appears. Next, we identified encounters where symptomatically-similar diagnoses (SSD) were noted. We then performed a change-point analysis to identify the time window prior to the index bladder cancer diagnosis where diagnostic opportunities first appeared. Finally, we used a simulation model to estimate the likelihood that SSDs represented missed opportunities for an earlier bladder cancer diagnosis.RESULTS: The study cohort included 157,968 patients with bladder cancer (112,265 (71.1%) males; 45,703 (28.9%) females). Based on a rapid increase in the number of SSD visits plotted over time (Figure ), we estimate that the mean time prior to bladder cancer diagnosis that diagnostic opportunities existed was 106 (102-111) days. Within this window, 374,861 visits (70.6% of patients) had at least 1 SSD, the most common being hematuria (66.6%), urinary tract infection (50.5%) and urinary symptoms (26.3%). Of these visits, we estimate that 191,762 visits (CI 187,016), among 69,015 patients (CI 68,758), represent a diagnostic delay, the median duration being 31.3 days. Approximately 27% experienced a delay of > 50 days and 9% > 70 days. On average, patients with diagnostic delay had 2.78 (CI 2.74-2.83) visits with SSDs prior to diagnosis of bladder cancer.CONCLUSIONS: In this insured population of patients, bladder cancer patients began to present with SSDs on average 106 days prior to formal diagnosis. Utilizing simulation models, we estimate that many of these patients had diagnostic delay. Future work will quantify the impact of these delays and ways to ameliorate.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.