Purpose: The aim of this survey was to obtain an overview of current European standards in the endoscopic visualization and management of bladder tumors.
Methods: An online survey was launched in July 2018 for a duration of 4 months.
It was distributed to all members of the European Association of Urology (EAU) and included 23 questions divided into 3 thematic sections: general information, white light cystoscopy (WLC) and imaging, and transurethral resection of bladder tumors (TURBT) techniques.
Results: Responses of 222 participants were included for analysis. The majority of physicians were aged between 30 and 40 years (48.2%, n=107) and performed over 50 TURBT per year (52.2%, n=115). Overall, 52.3% (n=116) reported WLC findings in written form only, 23.8% (n=53) added endoscopic footage, and 79.2% (n=176) considered preliminary WLC/TURBT reports before performing a subsequent bladder intervention. About half of the participants (50.5%, n=104) used additional tumor visualization methods (aTVMs), but aTVMs were utilized by a greater proportion of physicians from Western countries (58.1%, n=90) compared to developing countries (20.0%, n=7). Photodynamic diagnosis was the predominant aTVM technique employed (43.8%, n=60). Bipolar current was the most common technique for TURBT (46.6%, n=149). Most urologists in this study occasionally utilized techniques like resections in fractions (80%, n=161) or en bloc resection (87.2%, n=182). A repeated TURBT was performed when no muscle was found in the specimen (70.6%, n=149) and/or if the tumor was stage pT1 (72.0%, n=152) or HG (63.0%, n=133).
Conclusion: Implementation of resection techniques or repeated TURBT within EAU guidelines is promising, but it can be further challenged. For example, WLC/TURBT reporting should be improved since urologists consistently consider previous documentation. Given the moderate application rate of aTVMs, an attempt to increase its utilization would lead to a better assessment of its potential benefit.
Journal of endourology. 2019 Oct 16 [Epub ahead of print]
Frank Waldbillig, Simon Hein, Britta Grüne, Rodrigo Suarez, Evangelos N Liatsikos, Georg Salomon, Alexander Reiterer, Christian Gratzke, Arkadiusz Miernik, Maximilian Kriegmair, Manuel Ritter
University Medical Center Mannheim, Heidelberg University, Department of Urology, Mannheim, Germany., University Medical Center Freiburg, Freiburg University, Department of Urology, Freiburg, Germany., University Medical Center Patras, Departement of Urology, Patras, Greece; ., University Hospital Hamburg, Martini Clinic, Prostate Cancer Centre, Hamburg, Germany; ., Fraunhofer Institute for Physical Measurement Techniques, 28468, IPM, Freiburg, Baden-Württemberg, Germany., University Medical Center Freiburg, Freiburg University, Department of Urology, Freiburg, Germany; ., University Medical Center Bonn, Bonn University, Department of Urology and Pediatric Urology, Bonn, Germany.