Bimanual palpation for staging of bladder cancer-clinical use and its predictors.

OBJECTIVE: To analyze the frequency of performing bimanual palpation (BP) during transurethral resection of the bladder tumor (TURBT) and to identify its predictors. MATERIAL AND METHODS: This retrospective analysis enrolled 568 consecutive patients, who underwent TURBT due to primary bladder cancer. There were thirty surgeons involved in the analysis, each performed a mean of 18.9 TURBTs (range 1-43). Univariate and multivariate logistic regression analyses were performed to identify factors predicting the BP use. RESULTS: Two hundred and sixty-five patients (46.7%) underwent BP. BP was performed in 36.1% of Ta tumors, 49.1% of T1 tumors and 76.6% of ≥T2 tumors (p<0.001); in 60.2% of tumors >3 cm and in 33.3% of tumors <3 cm (p<0.001). Female, and male doctors performed BP in 38.3%, and 48.8% of the cases, respectively (p=0.01). Senior residents performed BP more often than junior residents and certified junior and senior urologists (64.6% vs. 39.2% vs. 48.2% vs. 31.1%, respectively; p=0.03). In multivariate logistic regression analysis higher tumor stage, larger tumor size, as well as senior residents and male surgeons performing TURBT were independent predictors of BP. CONCLUSION: Though BP is recommended for each patient at the time of TURBT, it is performed only in the minority of patients undergoing TURBT, mainly those with advanced or larger tumors, operated by senior residents and male surgeons.

Availability and Patterns of Intravesical BCG Instillations.

PURPOSE: Intravesical BCG instillations improve recurrence free survival in patients with non-muscle-invasive bladder cancer (NMIBC). METHODS: This is a national survey study, covering 223 urological centres, aimed at reliable identification of BCG availability and implemented treatment patterns. RESULTS: Response rate was 93.7%. BCG was used in 56.5% of urological departments. Another 22.7% referred patients to other hospitals for instillations, while 20.8% did not recommend BCG at all. The most common indications for BCG instillations were as follows: T1 tumours (88.5%), carcinoma in situ (83.6%) and high grade tumours (73.8%). Maintenance therapy was routinely abandoned in 16.4% of centres or was scheduled for <1 year, 1 year, 3 years and 1-3 years in 6.6%, 19.7%, 21.3% and 31.2% of centres, respectively. Continuation of BCGdespite treatment failure in carcinoma in situ cases was considered in 21.3% of departments. CONCLUSION: Our findings indicate that BCG is underused, while patterns of maintenance and follow-up are suboptimal.