Discrepancy Between European Association of Urology Guidelines and Daily Practice in the Management of Non–muscle-invasive Bladder Cancer: Results of a European Survey

Hendricksen, Kees; Aziz, Atiqullah; Bes, Paula Cacciatore; Chun, Felix K.‐H.; Dobruch, Jakub; Kluth, Luis A.; Gontero, Paolo; Necchi, Andrea; Noon, Aidan P.; Rhijn, Bas W.G. van; Rink, Michael; Roghmann, Florian; Rouprêt, Morgan; Seiler, Roland; Shariat, Shahrokh F.; Qvick, B.; Babjuk, Marek; Xylinas, Évanguelos

doi:10.1016/j.euf.2017.09.002

Cited by 53 publications

(56 citation statements)

References 22 publications

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“…A recent literature review summarized available evidence from multinational studies regarding adherence to AUA, Society of Urologic Oncology, and EAU guidelines for NMIBC and found poor compliance regarding repeat TURBT for high-risk tumors (range 28-43%) [7]. We showed repeat TURBT rates of 77.5%, which mirrors recent findings from a large-scale multinational European survey study, reporting 80% of surveyed urologists advocating a repeat TURBT in the high-risk setting [5]. In our study, the poorest guideline compliance within the 3 metrics was observed for adjuvant instillation therapy with only 62.2% of patients receiving adequate subsequent treatment.…”

Section: Discussionsupporting

confidence: 73%

“…Given the greater propensity of progression in patients with tumors invading the subepithelial connective tissue (pT1), the current gold standard treatment for this stage includes repeat TURBT and intravesical instillation therapies, whereas even early cystectomy can be considered in therapy refractory cases [4]. Worldwide, appropriate observations have been made regarding poor guideline adherence during the treatment of patients with NMIBC [5][6][7][8]. Against this backdrop, our aim was to mirror contemporary guideline adherence focusing on pT1 NMIBC and to evaluate patients from 4 German institutions.…”

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confidence: 99%

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Evaluating Guideline Adherence for T1 Bladder Cancer Treatment and Surveillance: A Retrospective German Multicenter Observation

et al. 2018

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Introduction: To mirror guideline-adherence for pT1 bladder cancer treatment in Northern Germany. Materials and Methods: Overall, 111 patients with pT1 diagnosis were treated at 4 institutions. Guideline-adherence was defined as repeat resection, instillation, and quarterly cystoscopy. Patient characteristics and pathological parameters were assessed. We summarized patients using descriptive analyses and evaluated guideline-adherence within selected subgroups. We created a multivariable model to identify predictors of guideline-adherence. Results: Median age was 75 years (range 39–94 years), multifocal tumors were found in 44.1%, early instillation was performed in 33.3%, and repeat resection was performed in 77.5%. Of 62.2% who underwent instillation, 59.4% received BCG, while 40.6% received Mitomycin C or other agents. Cystoscopic follow-up was performed in 81.8%. Guideline-adherence was met in 56.8%. Patients aged below the median met adherence metrics more often compared to those above the median (66.7 vs. 46.3%; p = 0.030). Men more frequently met adherence metrics compared to women (62.1 vs. 37.5%; p = 0.038). More patients with multifocal tumors met all 3 adherence metrics (69.4 vs. 48.0%; p = 0.050), as compared to those with unifocal lesions. In multivariable analyses, age-adjusted comorbidity (OR 0.75; 95% CI 0.59–0.94; p = 0.011) and multifocality (OR 2.62; 95% CI 1.09–6.27; p = 0.031) were predictors of guideline-adherence. Conclusions: We found non-adherence in more than one-third of patients and disparities among patients of different age and according to tumor focality. Larger samples and prospective studies are needed to delineate and eradicate treatment disadvantages in these high-risk patients.

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Section: Discussionsupporting

confidence: 73%

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confidence: 99%

Evaluating Guideline Adherence for T1 Bladder Cancer Treatment and Surveillance: A Retrospective German Multicenter Observation

et al. 2018

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“…Second TURBT (re-TURBT) was performed by the same urologist who performed the first TURBT within 6 wk [8]. The re-TURBT protocol included resection of the tumor scar and base, together with the bladder neck (for CIS) and red bladder patches.…”

Section: Patient Populationmentioning

confidence: 99%

Systemic Inflammatory Markers and Oncologic Outcomes in Patients with High-risk Non–muscle-invasive Urothelial Bladder Cancer

Cantiello

Russo

Vartolomei

et al. 2018

European Urology Oncology

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Background: Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC). Objective: To evaluate the prognostic role of the combination of the neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) in patients with high-risk non-muscle-invasive urothelial BC (NIMBC). Design, setting, and participants: A total of 1151 NMIBC patients who underwent first transurethral resection of the bladder tumor (TURBT) at 13 academic institutions between January 1, 2002 and December 31, 2012 were included in this analysis. The median follow-up was 48 mo. Intervention: TURBT with intravesical chemotherapy or immunotherapy.

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“…Bladder cancer (BC) is the fourth most commonly diagnosed cancer in men and the eighth most lethal [1]. Optimal detection and surveillance of BC rely primarily on the cystoscopic visualization and accurate documentation of all bladder lesions [2,3]. There are presently two main drawbacks associated with the current diagnostic approach.…”

Section: Introductionmentioning

confidence: 99%

Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries

et al. 2020

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Introduction: To assess the current diagnostic, treatment, and documentation strategies for bladder cancer (BC) in German-speaking countries. Materials and Methods: A 14-item web-based survey was distributed among members of the German, Austrian, and Swiss Associations of Urology, addressing physicians who perform cystoscopies and transurethral resection of bladder tumors (TURB). Results: The survey was responded to by 308 of 5,564 urologists with a mean age of 49.5 years (response rate: 5.5%). The majority of participants (57.3%) practice in an outpatient setting. White light cystoscopy only is used by 60.2%, with additional photody-namic diagnosis and narrow band imaging by 36.8 and 12.5%, respectively. Endoscopic findings are documented in written form by 93.5%, followed by image capture (33.7%) and a central data archive (20.8%). Inpatient hospital urologists document cystoscopic findings by freehand drawing (21.4 vs. 11.4%, p = 0.017), and with a fixed bladder scheme (31.3 vs. 7.4%, < 0.05) significantly more frequently. Cystoscopic findings are mainly conveyed to other health professionals in written form (77.4%), and significantly more often by inpatient urologists (p < 0.05). Conclusions: Significant differences exist in the approach to documenting and communicating cystoscopic BC findings. Accurate graphic documentation of lesions, visualization of the mucosa's totality, and meticulous consultation of previous surgical reports require improvements to reduce recurrence and progression rates.

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Discrepancy Between European Association of Urology Guidelines and Daily Practice in the Management of Non–muscle-invasive Bladder Cancer: Results of a European Survey

Cited by 53 publications

References 22 publications

Evaluating Guideline Adherence for T1 Bladder Cancer Treatment and Surveillance: A Retrospective German Multicenter Observation

Evaluating Guideline Adherence for T1 Bladder Cancer Treatment and Surveillance: A Retrospective German Multicenter Observation

Systemic Inflammatory Markers and Oncologic Outcomes in Patients with High-risk Non–muscle-invasive Urothelial Bladder Cancer

Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries

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