Patient tolerability during office cystoscopy and bladder tumor cauterization: a multivariate analysis of risk factors.

OBJECTIVE: Cystoscopy and cauterization performed in the operating room is expensive and exposes patients to anesthesia risks. Patient tolerability during office cystoscopy and cauterization is critical to the office management of bladder cancer (BC) and other urologic diseases. We evaluated the risk factors for pain of flexible cystoscopy in the office-setting with emphasis on a sub-group of BC patients who underwent cauterization. MATERIALS AND METHODS: Retrospective analyses of 110 anonymous patient surveys completed after cystoscopy and/or cauterization. Survey information included age, gender, indication for cystoscopy, number of prior cystoscopies, number of prior office-based cauterizations, anxiety prior/during cystoscopy, and pain during cystoscopy and/or cauterization. Univariate/multivariate and linear-regression analyses were performed to evaluate the association of pain with clinical parameters. RESULTS: Average pain during cystoscopy (1.75 ±â€¯1.331) was not significantly different when cauterization was also performed (2.37 ±â€¯2.214) (p < 0.001) (p = 0.2840). Patients in the lower age group (<66 years) indicated higher anxiety levels (p = 0.0005), more pain at cystoscopy (P = 0.004) and cauterization (p < 0.001). Although the patients' overall anxiety level was low (1-3/10), it was associated with some pain during cystoscopy (p = 0.0005) and cauterization (p < 0.000). In multivariate analysis, anxiety was the only independent predictor of pain during cystoscopy (p = 0.03, OR: 6.52,95% CI: 1.2-35.6) and cauterization (p = 0.0012, OR: 3.4, 95%CI: 1.6-7.0). In BC patients, pain scores during cystoscopy and cauterization were not significantly different (p = 0.4772) but associated with anxiety. CONCLUSION: Office-based cystoscopy and cauterization are tolerable with minimal pain. Higher pain levels during cystoscopy were associated with procedure anxiety, and pain during cauterization was associated with procedure anxiety and younger age. Younger and more anxious patients may need more counseling before cystoscopy.

Vigilancia y manejo en consulta de los tumores de vejiga Ta de bajo grado / Surveillance and office management of low-grade Ta bladder tumors

Objetivo: Los pacientes con cáncer de vejiga (CV) Ta, de grado bajo (GB) 1-2, presentarán con frecuencia una «recidiva», aunque rara vez una progresión a un estadio más avanzado. Si bien las directrices actuales mencionan la vigilancia y el manejo en consulta para estos tumores nuevos o recurrentes, la resección transuretral es el tratamiento realizado con mayor frecuencia. El objetivo de este estudio es determinar la seguridad de la vigilancia y/o la cauterización ambulatoria. Materiales y métodos: Este estudio se llevó a cabo como un análisis retrospectivo de una serie de casos de 45 pacientes que tenían CV recurrente con apariencia de GB Ta y que fueron tratados principalmente con vigilancia y/o cauterización en la consulta. Se excluyeron los pacientes con carcinoma in situ. La variable de valoración principal fue la progresión a un estadio más avanzado. Resultados: La mediana de seguimiento fue de 62 meses. En 41 (91%) pacientes no hubo progresión del estadio. Tres pacientes recidivaron con CV grado alto (GA) T1; uno de ellos está recibiendo inmunoterapia sistémica. Un paciente desarrolló un CV GA T2 y fue tratado con un protocolo preservador de la vejiga. A 40 (89%) pacientes se les realizó cauterización en consulta. Once recibieron BCG y 26 recibieron quimioterapia intravesical tras la cauterización. Cinco (11%) pacientes desarrollaron CV GA durante el seguimiento. Ningún paciente falleció. Ninguno de los 17 (38%) pacientes hispanos tuvo progresión.ConclusionesLa vigilancia activa y/o la cauterización ambulatoria para pacientes con tumores vesicales pequeños GB Ta es segura, reduce costes y mejora la calidad de vida al evitar las resecciones transuretrales. (AU)

Objective: Patients with low-grade (LG), grade 1-2, Ta bladder cancer (BC) will frequently have a “recurrence”. However, they rarely progress in stage. Although current guidelines mention surveillance and office management for these new or recurrent tumors, transurethral resection is the most common treatment. The purpose of this study is to determine if surveillance and/or office cautery is safe. Materials and methods: This study was conducted as a retrospective case series analysis of 45 patients who had recurrent LG Ta appearing BC and were managed primarily with surveillance and/or office cautery. Patients with carcinoma in-situ were excluded. The primary outcome was stage progression. Results: Median follow-up was 62 months. Forty-one (91%) patients did not progress in stage. Three patients recurred with high grade (HG) T1 BC; one is receiving systemic immunotherapy. One patient developed HG T2 BC and was treated with a bladder preservation protocol. Forty (89%) patients underwent office cauterization. Eleven received BCG and 26 received post-cautery intravesical chemotherapy. Five (11%) patients developed HG BC during follow-up. No patients died. None of the 17 (38%) Hispanic patients had progression. Conclusions: Active surveillance and/or office cautery for patients with small recurrent LG Ta bladder tumors is safe, reduces cost and improves quality of life by avoiding transurethral resections. (AU)

Surveillance and office management of low-grade Ta bladder tumors.

OBJECTIVE: Patients with low-grade (LG), grade 1-2, Ta bladder cancer (BC) will frequently have a "recurrence". However, they rarely progress in stage. Although current guidelines mention surveillance and office management for these new or recurrent tumors, transurethral resection (TURBT) is the most common treatment. The purpose of this study is to determine if surveillance and/or office cautery is safe. MATERIALS AND METHODS: This study was conducted as a retrospective case series analysis of 45 patients who had recurrent LG Ta appearing bladder cancer (BC) and were managed primarily with surveillance and/or office cautery. Patients with carcinoma in-situ were excluded. The primary outcome was stage progression. RESULTS: Median follow up was 62 months. 41 (91%) patients did not progress in stage. Three patients recurred with HG T1 BC; one is receiving systemic immunotherapy. One patient developed HG T2 BC and was treated with a bladder preservation protocol. 40 (89%) patients underwent office cauterization. Eleven received BCG and 26 received post-cautery intravesical chemotherapy. Five (11%) patients developed HG BC during follow up. No patients died. None of the 17 (38%) Hispanic patients had progression. CONCLUSIONS: Active surveillance and/or office cautery for patients with small recurrent LG Ta bladder tumors is safe, reduces cost and improves quality of life by avoiding TURBTs.