A Google Trends™ Analysis of Bladder Cancer: Determining Awareness Campaign Success, and Patients' Needs in Clinical Management.

OBJECTIVE: We aimed to determine the interest and changing trends over time in the diagnosis and treatment of bladder cancer and its awareness campaign by examining the Google Trends application as an indicator of people's interest globally. METHODS: Using the Google Trends application, we determined the yearly and country-based relative search volumes of the term "bladder tumor" and of the methods used in the diagnosis and treatment of bladder cancer in the period from January 2004 to December 2019. We compared the median relative search volumes found in the period 2004-2011 (Period 1) with those found in the period 2012-2019 (Period 2). RESULTS: We found that the median relative search volume for bladder cancer decreased in period 2 and this was parallel to the decrease in the incidence rates in North America and Australia (p<0.001). We found that the bladder cancer awareness month did not cause an increase in the online interest (p>0.05). We found that the median relative search volumes of diagnostic cystoscopy and cytology were higher than those of molecular markers and imaging methods in line with guidelines (p<0.001). Also, TURBT was the most sought-term among treatment methods with increasing popularity in the second period (p<0.001). CONCLUSION: People use the internet intensively to search for information about bladder cancer. We think that several types of web-based applications such as "Google Trends" can help determine the behavioural patterns and tendencies of bladder cancer patients and affect the clinical decision-making processes, as well as readily determining the impact of cancer awareness campaigns to bring about an increased awareness in the society for the recognition of the importance of an early diagnosis.

Recent Trends in Transurethral Surgeries and Urological Outpatient Procedures: a Nationwide Population-based Cohort Study.

BACKGROUND: Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire population-based cohort. METHODS: We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. RESULTS: Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R² = 0.98; P < 0.001). The transurethral bladder surgery increased by 65.5% from 12,482 in 2009 to 20,658 in 2016 (B = 1,149; R² = 0.97; P < 0.001). Over the 8-years period, there were not significant changes in transurethral prostate (B = 43; R² = 0.04; P = 0.617) and urethral surgery (B =-12; R² = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R² = 0.95; P < 0.001) and uroflowmetry (B = 53,942; R² = 0.99; P < 0.001) were observed during the 8-year period. There was no difference in bladder catheterization during the 8-year period. Urodynamic study (UDS: B =-2,156; R² = 0.77; P = 0.003) and electrical stimulation treatment (EST: B =-1,034; R² = 0.87; P < 0.001) significantly decreased. CONCLUSION: In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

Bipolar en Bloc Resection - Is it the Future in Non-Muscle Invasive Bladder Cancer?

Bladder cancer is among the most common urological malignancies. In this context, despite of all the technological advancements, transurethral resection of bladder tumour (TURBT) continues to represent the gold-standard diagnostic and treatment in non-muscle invasive bladder tumours (NMIBTs). The surgical technique of en bloc bipolar tumour resection could be performed using the hemispherical shape plasma-button electrode and saline irrigation fluid or using the laser fiber. The malignant formation is gradually pushed up and separated from the bladder wall. The final aspect of the bladder wall reveals the clean muscular fibers of the detrusor layer, free of malignant tissue, irregularities or debris. Concerning the outcomes, the operative parameters are heterogenous in the literature, because of the different resection devices utilized. However, there are few main points where all the studies agreed, concerning the lower recurrence rates comparing with classical resection and also the good quality resection samples. In conclusion, even if the general outcomes are favourable for the en bloc resection, there is still a lack of large multicentric comparative trials which establish the right place of the method in the urological armamentarium.

[Surgical treatment of bladder cancer: advances made in the past 50 years]. / Operative Therapie des Harnblasenkarzinoms: Fortschritte der letzten 50 Jahre.

The past 5 decades have seen major advances in the surgical treatment of bladder cancer, which have significantly reduced the morbidity and mortality of the disease. Enhanced understanding of tumour biology as well as a large number of newly developed endoscopic instruments and techniques have contributed to making treatment more successful. Moreover, modified and improved surgical techniques of radical cystectomy have been implemented and the clinical and pathological risk stratification of patients has been improved. Hence, patients are treated differently according to risk groups. Treatment algorithms range from repeated transurethral resections to adjuvant intravesical therapy to radical cystectomy, which may be part of a multimodal approach with curative intent. Celebrating the 50th anniversary of "Aktuelle Urologie", we summarise the most important advances in the treatment of BC since 1969 and report some current trends. Modern endoscopic imaging techniques ("enhanced cystoscopy") and molecular subtyping of BC may further improve risk stratification. Moreover, some initial experience has been made with robot-assisted radical cystectomy, and there are new trends for the standardisation of techniques, concepts of enhanced recovery after surgery, as well as initiatives for the measurement of surgical quality and patient-reported outcomes. We believe that all these current developments may help to further improve the quality of life and therapeutic outcome of patients with BC.

Profilaxis antibiótica en la uretrocistoscopia flexible. Perspectivas para latinoamérica y el caribe / No disponible

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Tamaño muestral y establecimiento de la seguridad en la medicina perioperatoria / Sample size and the establishment of safety in perioperative medicine

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National Trend of Uroflowmetry, Urodynamic Study and Cystoscopy Considering the Change in the Population Structure in Korea from 2010 to 2015.

BACKGROUND: Although lower urinary tract symptoms (LUTS) show a higher prevalence with age, few studies have reported the trend of these examination tools including uroflowmetry, urodynamic study and cystoscopy. METHODS: We evaluated the trend of performance of uroflowmetry, urodynamic study and cystoscopy by using National Health Insurance Data from 2010 to 2015. Primary outcome findings included cumulative number of patients per year, cumulative age-standardized patient rate per year and per age group, and correlation between the number of patients per year and the percentage of population per year in each age group. RESULTS: The overall trend for frequency of uroflowmetry and cystoscopy showed an increasing pattern (P < 0.001, respectively) while the trend for frequency of urodynamic study showed a decreasing pattern (P < 0.001). After age standardization, the overall trend showed similar results. Correlation between the number of patients per year and the percentage of population per year showed a positive correlation in the 50s age group and the above 70s age group (P = 0.003 and < 0.01, respectively) on uroflowmetry and in the above 70s age group (P < 0.01) on cystoscopy. Urodynamic study showed negative correlations in the 50s age group and the above 60s age group (P = 0.001 and 0.01, respectively). CONCLUSION: National trend for frequency of uroflowmetry, urodynamic study and cystoscopy showed a different trend. The increasing trend of uroflowmetry and cystoscopy was related with growth of the aged population. However, urodynamic study showed a decreasing trend regardless of the age group.

Advancements in optical techniques and imaging in the diagnosis and management of bladder cancer.

Accurate detection and staging is critical to the appropriate management of urothelial cancer (UC). The use of advanced optical techniques during cystoscopy is becoming more widespread to prevent recurrent nonmuscle invasive bladder cancer. Standard of care for muscle-invasive UC includes the use of computed tomography and/or magnetic resonance imaging, but staging accuracy of these tests remains imperfect. Novel imaging modalities are being developed to improve current test performance. Positron emission tomography/computed tomography has a role in the initial evaluation of select patients with muscle-invasive bladder cancer and in disease recurrence in some cases. Several novel immuno-positron emission tomography tracers are currently in development to address the inadequacy of current imaging modalities for monitoring of tumor response to newer immune-based treatments. This review summaries the current standards and recent advances in optical techniques and imaging modalities in localized and metastatic UC.

Novel endoscopic visualization techniques for bladder cancer detection: a review of the contemporary literature.

PURPOSE OF REVIEW: To describe the principles of photodynamic diagnosis (PDD), narrow-band imaging (NBI) and Storz Professional Image Enhancement System (SPIES) techniques for the endoscopic management of nonmuscle-invasive bladder cancer (BCa) and to report their impact on clinical practice. RECENT FINDINGS: PDD is associated with an increased sensitivity for detecting BCa specifically carcinoma in situ (CIS). Moreover, PDD has been shown to lower recurrence rate in comparison with white-light cystoscopy. The impact on progression-free survival is still unclear yet. NBI and, more recently, SPIES are two novel imaging techniques that do not require preoperative instillation of photosensitizing agents. NBI seems to be associated with lower recurrence rates. Nevertheless, further trials are necessary to confirm these results, in particular in high-risk lesions and CIS. Randomized clinical trials addressing the clinical impact of SPIES are ongoing. SUMMARY: Novel endoscopic imaging techniques are useful diagnostic tools for evaluating BCa during cystoscopic diagnostic surveillance as well as during transurethral resection of the bladder. Although the standard of care remains white-light cystoscopy, these techniques provide higher sensitivity in detecting BCa especially CIS. The continued evidence also suggests that this increased detection leads to lower recurrence rates. The impact on progression and the cost-efficacy as well as selection remains to be refined.

Observational Studies Requested by European Health Authorities: Governmental Interference or an Enhancement of Everyday Urological Practice? The Hexvix® Observational Patients Evaluation Study as an Example of What to Expect.

OBJECTIVE: The Hexvix® Observational Patients Evaluation (HOPE) study was designed to determine the extent of distribution of the use of hexaminolevulinate in the diagnosis of non-muscle invasive bladder cancer (NMIBC) and assess patient and treatment characteristics associated with different endoscopic modalities and to address the French authorities' request for information on routine practices for NMIBC diagnosis and surveillance. PATIENTS AND METHODS: A prospective, observational study in 30 centres in France with fluorescence endoscopy equipment available. All candidates for endoscopy with transurethral resection who gave their consent were eligible. The primary endpoint was the proportion of patients with an NMIBC diagnosis performed with hexaminolevulinate. RESULTS: 506 patients were included: 252 (49.8%) diagnosed with hexaminolevulinate and 254 (50.2%) with white-light endoscopy alone. There were more patients with tumour recurrence, multiple lesions, lesions with a diameter <3 cm, stage Ta disease, and grade 1 lesions in the hexaminolevulinate group. The first quartile median recurrence-free survival time was 310 days in the hexaminolevulinate group and 144 days in the standard-endoscopy group (p = 0.0015). CONCLUSION: Hexaminolevulinate was in frequent use in France with specific patient and disease characteristics associated with its use. HOPE illustrates the type of data that can be gained in post-authorisation studies to address requests from European health authorities.

The diagnostic accuracy of urine-based tests for bladder cancer varies greatly by patient.

BACKGROUND: Spectrum effects refer to the phenomenon that test performance varies across subgroups of a population. When spectrum effects occur during diagnostic testing for cancer, difficult patient misdiagnoses can occur. Our objective was to evaluate the effect of test indication, age, gender, race, and smoking status on the performance characteristics of two commonly used diagnostic tests for bladder cancer, urine cytology and fluorescence in situ hybridization (FISH). METHODS: We assessed all subjects who underwent cystoscopy, cytology, and FISH at our institution from 2003 to 2012. The standard diagnostic test performance metrics were calculated using marginal models to account for clustered/repeated measures within subjects. We calculated test performance for the overall cohort by test indication as well as by key patient variables: age, gender, race, and smoking status. RESULTS: A total of 4023 cystoscopy-cytology pairs and 1696 FISH-cystoscopy pairs were included in the analysis. In both FISH and cytology, increasing age, male gender, and history of smoking were associated with increased sensitivity and decreased specificity. FISH performance was most impacted by age, with an increase in sensitivity from 17 % at age 40 to 49 % at age 80. The same was true of cytology, with an increase in sensitivity from 50 % at age 40 to 67 % at age 80. Sensitivity of FISH was higher for a previous diagnosis of bladder cancer (46 %) than for hematuria (26 %). Test indication had no impact on the performance of cytology and race had no significant impact on the performance of either test. CONCLUSIONS: The diagnostic performance of urine cytology and FISH vary significantly according to the patient demographic in which they were tested. Hence, the reporting of spectrum effects in diagnostic tests should become part of standard practice. Patient-related factors must contextualize the clinicians' interpretation of test results and their decision-making.

Comparative analysis of gender-related differences in symptoms and referral patterns prior to initial diagnosis of urothelial carcinoma of the bladder: a prospective cohort study.

OBJECTIVE: To analyze gender-specific differences regarding clinical symptoms, referral patterns and tumor biology prior to initial diagnosis of urothelial carcinoma of the bladder (UCB). METHODS: A consecutive series of patients with an initial diagnosis of UCB was included. All patients completed a questionnaire on demographics, clinical symptoms and referral patterns. RESULTS: In total, 68 patients (50 men, 18 women) with newly diagnosed UCB at admission for transurethral resection of bladder tumors were recruited. Dysuria was more often observed in women (55.6 vs. 38.0%, p = 0.001). Direct consultation of the urologist was conducted by 84.0% of males and 66.7% of females (p = 0.120). One third of the women saw their general practitioner and/or gynecologist once or twice (p = 0.120) before referral to the urologist. Furthermore, women were significantly more often treated for urinary tract infections than men (61.1 vs. 20.0%, p = 0.005). Cystoscopy at first presentation to the urologist was more often performed in men than women (88.0 vs. 66.7%, p = 0.068), with a more favorable tumor detection rate at first cystoscopy in men (96.0 vs. 50.0%, p < 0.001). CONCLUSIONS: Delayed referral patterns might lead to deferred diagnosis of UCB and consequently to adverse outcome. Thus, primary care physicians might consider referring patients with bladder complaints to specialized care earlier.

Invasive urothelial carcinoma detected in bladder diverticulum with FDG PET/CT: A rare case with negative cystoscopy / Detección de carcinoma urotelial invasivo sobre divertículo vesical mediante FDG PET/TAC. Un caso raro con cistoscopia negativa

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Placenta percreta con invasión vesical: una causa infrecuente de hematuria en la embarazada / Placenta percreta with bladder invasion: an uncommon cause of hematuria during pregnancy

La placenta percreta con invasión de la vejiga es una entidad muy infrecuente que puede producir complicaciones muy graves para la embarazada. Aunque a menudo se diagnostica en el momento del parto, las técnicas de imagen son muy útiles para diagnosticarla precozmente, lo que resulta fundamental para la planificación quirúrgica y evitar complicaciones potencialmente mortales. Presentamos un caso de esta entidad, y realizamos un breve repaso bibliográfico, con énfasis en el papel de las técnicas de imagen. Se trata de una gestante con antecedente de cesárea previa, hematuria y dolor lumbar. Tras realizar una ecografía y una resonancia magnética, se sugirió el diagnóstico de placenta percreta con invasión vesical, que se confirmó quirúrgicamente (AU)

Placenta percreta with bladder invasion is a very uncommon condition that can lead to very severe complications in pregnant women. Although it is often diagnosed during delivery, imaging techniques are very useful for early diagnosis, which is fundamental for planning surgery and avoiding potentially lethal complications. We present the case of a woman with a history of cesarean section who presented with hematuria and low back pain. The diagnosis of placenta percreta with bladder invasion was suggested after ultrasonography and magnetic resonance imaging and was confirmed at surgery. We provide a brief review of the literature, emphasizing the role of imaging techniques (AU)

Hematuria incoercible generada en la amiloidosis sistémica con afectación vesical / Intractable hematuria secondary to systemic amyloidosis with bladder involvement

OBJETIVO: Presentar el manejo terapéutico de la hematuria incoercible generada en la amiloidosis sistémica con afectación vesical. MÉTODO: Descripción del caso clínico, el manejo médico, la técnica endourológica utilizada y de los resultados con apoyo de la literatura publicada al respecto. RESULTADOS: Mujer de 50 años con antecedentes personales de artritis reumatoide (AR) de 20 años de evolución en tratamiento crónico con corticoides y AINES así como insuficiencia renal crónica sin necesidad de hemodiálisis, que tras 24 horas de la resección de un quiste hidatídico hepático presenta hematuria incoercible. Ecografía y TAC revelan gran coágulo vesical organizado sin repercusión de la vía urinaria. La cistoscopia intraoperatoria muestra una vejiga distendida de aspecto inflamatorio con sangrado difuso generalizado. Se realiza hemostasia y toma de biopsias de la mucosa asociando al lavado vesical alumbre potásico como hemostático. Dada la persistencia de la hematuria se procede a nueva revisión en quirófano más transfusión de hemoderivados en vista de la inestabilidad hemodinámica sin lograr control de la misma por lo que se realiza embolización selectiva. Se asocia instilación vesical con DMSO cada 72 hrs. para el control de la hematuria remanente. La biopsia revela el hallazgo de amiloidosis vesical agregándose al tratamiento corticoide intravenoso y colchicina oral controlando satisfactoriamente la clínica de la paciente. CONCLUSIONES: La amiloidosis vesical secundaria es una entidad que cursa con hematuria de difícil manejo. El control de la hematuria suele ser difícil por lo que además de los tratamientos conservadores a veces requiere de tratamientos más agresivos

OBJECTIVE: To present the therapeutic management of intractable hematuria secondary to systemic amyloidosis with bladder involvement. METHODS: We describe the clinical case, the medical management, the endo-urological technique used, and the results supported by relevant published literature. RESULTS: A 50-year-old woman with a 20-year history of rheumatoid arthritis in chronic treatment with corticosteroids and non-steroidal anti-inflammatory drugs in addition to chronic renal insufficiency not requiring hemodialysis. Twenty-four hours after resection of a hepatic hydatid cyst she presented intractable hematuria. The ultrasound and CT scan showed the formation of a large blood clot in the bladder not affecting the upper urinary tract. An intra-operative cystoscopy revealed a distended bladder showing signs of inflammation with diffuse, widespread bleeding. Hemostasis was achieved and a biopsy of the mucosa was taken, associated to bladder irrigation with potassium alum as a hemostatic. Given the persistence of the hematuria, further revision in the operating room as well as blood transfusion were carried out and, due to the hemodynamic instability that could not be controlled, finally selective embolization was performed. Intravesical instillation of dimethyl sulphoxide every 72 hours was used to control any remaining hematuria. The biopsy showed bladder amyloidosis. The addition of intravenous steroids and orally administered colchicine successfully controlled the patient’s clinical status. CONCLUSIONS: Secondary amyloidosis of the bladder is a condition associated with hematuria that is difficult to manage. Hematuria control is often difficult, requiring aggressive treatment in addition to more conservative approaches

[Photodynamic diagnostics of the bladder: current study results]. / Die photodynamische Diagnostik der Harnblase : Aktuelle Studienergebnisse.

The diagnosis and follow-up of bladder cancer is based on the so-called golden standard of urine cytology and white light endoscopy. In recent years fluorescence endoscopy, also known as photodynamic diagnosis (PDD), of the urinary bladder has become more and more popular. The rising interest in this procedure becomes clear when looking at the current literature. Nowadays, there are studies on PDD from all over Europe and the USA. This article gives an up to date review of these new studies and shows new developments in the outpatient use of PDD.

Endometriosis vesical aislada recidivante con repercusión renal / Recurrent isolated bladder endometriosis with renal involvement

La endometriosis vesical aislada es muy infrecuente y la aparición secundaria de hidronefrosis es un hecho escasamente descrito. La manifestación clínica más frecuente es el síndrome miccional cíclico y, en menor medida, la menuria. El método más sensible para su diagnóstico es la cistoscopia. Actualmente, el tratamiento que más se aplica es la resección transuretral con el uso posterior de análogos de la hormona liberadora de la hormona luteinizante(AU)

Isolated bladder endometriosis is very uncommon. A finding of secondary hydronephrosis has barely been described in the literature. The most common symptom is urethral syndrome and, to a lesser extent, menouria. The most sensitive diagnostic test for bladder endometriosis is cystoscopy. Currently, the most widely used treatment is transurethral resection, with subsequent ovarian suppression with luteinizing hormone-releasing hormone analogues(AU)

Ensayo clínico aleatorizado sobre profilaxis antibiótica en la uretrocistoscopia flexible / Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy

OBJETIVO: Uno de los principales inconvenientes de la uretrocistoscopia flexible es el riesgo de infección del tracto urinario (ITU). Para intentar reducir dicho riesgo se ha recurrido a la profilaxis antimicrobiana, aunque aún no hay un criterio unánime en cuanto a la pertinencia de su indicación, dosis, vía de administración y tipo de antibiótico de la misma. Para clarificar esta incertidumbre, hemos planteado un estudio experimental con el objetivo de valorar la eficacia de la quimioprofilaxis con 3 g de fosfomicina trometamol en la prevención de la ITU post uretrocistoscopia. MÉTODOS: Sesenta pacientes fueron incluidos en un ensayo clínico randomizado entre Marzo y Agosto del 2011. Treinta pacientes fueron asignados a un grupo control, que no recibió ninguna dosis de antibiótico, y el grupo de intervención (30 pacientes) recibió 3 g de fosfomicina trometamol. Díez días más tarde se realizó a todos los pacientes un sedimento y cultivo de orina. La bacteriuria significativa fué considerada a partir de > 105 UFC/ml. Un mes más tarde se llevó a cabo una encuesta telefónica para recoger los síntomas urinarios y la asistencia a su médico de familia. Estimamos la incidencia acumulada de bacteriuria, piuria y microhematuria en ambos grupos, y comparamos los resultados usando una estrategia de análisis por protocolo y por intención de tratar(AU)

RESULTADOS: La incidencia de bacteriuria, piuria y microhematuria fué en el grupo control del 10%, 23.3% y 26.7% respectivamente y en el de intervención los valores difirieron dependiendo del tipo de análisis. Considerando solamente los 27 pacientes (análisis por protocolo), las incidencias serían del 11,1%, 37,0% y 29,6%, respectivamente. Si incluimos los tres pacientes que no finalizaron el estudio (análisis por intención de tratar) y consideramos sus resultados como negativos, los resultados serían del 10%, 33,3% y 26,7%, respectivamente. Finalmente, en el caso de que los tres cultivos no realizados en este grupo hubieran arrojado un resultado positivo, las incidencias habrían sido de 20,0%, 43,3% y 36,7%. En cualquiera de los tres supuestos, las diferencias con respecto al grupo control no son estadísticamente significativas. CONCLUSIONES: En una población seleccionada y con unas medidas de asepsia adecuadas, la quimioprofilaxis no parece mostrar una reducción clínicamente relevante en la incidencia de ITU en pacientes sometidos a uretrocistoscopia flexible(AU)

OBJECTIVES: One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection (UTI). In order to reduce this risk, antimicrobial prophylaxis has been considered, however there is not a unanimous view regarding indications, dosage, type of antibiotic, and so on. To clarify this uncertainty, we practiced a pilot and experimental study aimed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy. METHODS: Sixty patients were entered into a pilot randomized clinical trial between March and August 2011. Thirty patients were assigned to a control group without receiving any antibiotic dose, and the intervention group (30 patients) received 3 g fosfomycin trometamol. Ten days later urine culture and sediment analysis were performed in all patients. Significant bacteriuria was considered from > 105 CFU /ml. One month later a telephone survey was developed to assess urinary symptoms, and assistance to the family doctor. We estimated the cumulative incidence of bacteriuria, pyuria and microhematuria in both groups, and we compared the results using a strategy of analysis per protocol and intention to treat(AU)

RESULTS: The incidence of bacteriuria, pyuria and microhematuria in the control group was 10%, 23.3% and 26.7% respectively and in the intervention groups the values differed depending on the type of analysis. Considering only the 27 patients (per protocol analysis), the incidence would be 11.1%, 37.0% and 29.6% respectively. If we include the three patients who did not completed the study (per intention to treat analysis) and considering their results as negative, the results were 10%, 33.3% and 26.7% respectively. Finally, in the case the three cultures not performed in this group had produced a positive result, the impact would have been 20.0%, 43.3% and 36.7%. In any of the three cases, the differences with the control group were not statistically significant. CONCLUSIONS: In a selected population and with appropriate aseptic measures, antibiotic chemoprophylaxis does not appear to show a clinically relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy(AU)