RESUMO
PURPOSE: To evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals. METHODS: Using a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases - between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service. RESULTS: In 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were 'very satisfied' with the UNP-led service. CONCLUSION: Our study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena.Through a supported training programme, urology nurses can deliver a high standard of service.
RESUMO
The management of transitional cell carcinoma of the bladder (TCCB) presents a challenge to urological surgeons due to the diversity of patient factors, stage at presentation and propensity for disease recurrence and progression. Advances in the last decade have seen an evolution in techniques for diagnosis, treatment and ongoing surveillance. A good understanding of our patients, the disease and the available diagnostic and therapeutic options is essential for the management of this condition. We review the current literature focusing on the merits of recent advances in this field. Given the breadth of the subject, we have deliberately selected only the most relevant and recent advances already in clinical use.
