Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey
| Autor: | Charis Kalogirou, Tanja Frank, Marie C. Hupe, Maximilian P Brandt, Thomas Stefan Worst, Julian P. Struck, Serkan Dogan, Franz F Dressler, Angelika Mattigk, Sebastian Hofbauer, Martin J.P. Hennig, Tim Nestler, Laura-Maria Krabbe, Mario W. Kramer, Nadim Moharam, Pia Paffenholz, Markus Grabbert, Philippe-Fabian Pohlmann, Johannes Salem, Henning Reis |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Urology Medizin Treatment management Resection German medicine Survey Urine cytology Bladder cancer medicine.diagnostic_test business.industry Mortality rate General surgery Guideline adherence Guideline Cystoscopy medicine.disease Checklist language.human_language language business Nonmuscle invasive bladder cancer 600 Technik Medizin angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit |
| DOI: | 10.17169/refubium-39770 |
| Popis: | Introduction: Guideline recommendations are meant to help minimize morbidity and to improve the care of nonmuscle invasive bladder cancer (NMIBC) patients but studies have suggested an underuse of guideline-recommended care. The aim of this study was to evaluate the level of adherence of German and Austrian urologists to German guideline recommendations. Methods: A survey of 27 items evaluating diagnostic and therapeutic recommendations (15 cases of strong consensus and 6 cases of consensus) for NMIBC was administered among 14 urologic training courses. Survey construction and realization followed the checklist for reporting results of internet e-surveys and was approved by an internal review board. Results: Between January 2018 and June 2019, a total of 307 urologists responded to the questionnaire, with a mean response rate of 71%. The data showed a weak role of urine cytology (54%) for initial diagnostics although it is strongly recommended by the guideline. The most frequently used supporting diagnostic tool during transurethral resection of the bladder was hexaminolevulinate (95%). Contrary to the guideline recommendation, 38% of the participants performed a second resection in the case of pTa low-grade NMIBC. Correct monitoring of Bacille Calmette-Guérin (BCG) response with cystoscopy and cytology was performed by only 34% of the urologists. Conclusions: We found a discrepancy between certain guideline recommendations and daily routine practice concerning the use of urine cytology for initial diagnostics, instillation therapy with a low monitoring rate of BCG response, and follow-up care with unnecessary second resection after pTa low-grade NMIBC in particular. Our survey showed a moderate overall adherence rate of 73%. These results demonstrate the need for sharpening awareness of German guideline recommendations by promoting more intense education of urologists to optimize NMIBC care thus decreasing morbidity and mortality rates. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|