Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey

Julian P Struck; Martin J P Hennig; Marie C Hupe; Nadim Moharam; Pia Paffenholz; Tim Nestler; Tanja Frank; Thomas S Worst; Markus Grabbert; Philippe-Fabian Pohlmann; Serkan Dogan; Sebastian L Hofbauer; Charis Kalogirou; Angelika Mattigk; Maximilian P Brandt; Laura-Maria Krabbe; Henning Reis; Franz F Dressler; Mario W Kramer; Johannes Salem

doi:10.1159/000518166

Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey

Urol Int. 2023;107(1):35-45. doi: 10.1159/000518166. Epub 2021 Aug 31.

Authors

Julian P Struck¹, Martin J P Hennig¹, Marie C Hupe¹, Nadim Moharam¹, Pia Paffenholz², Tim Nestler², Tanja Frank³, Thomas S Worst⁴, Markus Grabbert⁵, Philippe-Fabian Pohlmann⁵, Serkan Dogan⁶, Sebastian L Hofbauer⁷, Charis Kalogirou⁸, Angelika Mattigk⁹, Maximilian P Brandt¹⁰, Laura-Maria Krabbe¹¹, Henning Reis¹², Franz F Dressler¹³, Mario W Kramer¹, Johannes Salem¹⁴

Affiliations

¹ Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
² Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany.
³ Department of Urology and Pediatric Urology, RoMed Hospital Rosenheim, Rosenheim, Germany.
⁴ Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
⁵ Department of Urology, Medical Centre, University of Freiburg, Freiburg im Breisgau, Germany.
⁶ Department of Urology, Heilig Geist Hospital Cologne, Cologne, Germany.
⁷ Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁸ Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
⁹ Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany.
¹⁰ Department of Urology, University Hospital of Mainz, Mainz, Germany.
¹¹ Department of Urology, The University of Münster Medical Center, Münster, Germany.
¹² Institute of Pathology, University Hospital Essen, Essen, Germany.
¹³ Institute of Pathology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
¹⁴ Department of Urology, Clinic LINKS VOM RHEIN, Cologne, Germany.

PMID: 34515257
DOI: 10.1159/000518166

Abstract

Introduction: Guideline recommendations are meant to help minimize morbidity and to improve the care of nonmuscle invasive bladder cancer (NMIBC) patients but studies have suggested an underuse of guideline-recommended care. The aim of this study was to evaluate the level of adherence of German and Austrian urologists to German guideline recommendations.

Methods: A survey of 27 items evaluating diagnostic and therapeutic recommendations (15 cases of strong consensus and 6 cases of consensus) for NMIBC was administered among 14 urologic training courses. Survey construction and realization followed the checklist for reporting results of internet e-surveys and was approved by an internal review board.

Results: Between January 2018 and June 2019, a total of 307 urologists responded to the questionnaire, with a mean response rate of 71%. The data showed a weak role of urine cytology (54%) for initial diagnostics although it is strongly recommended by the guideline. The most frequently used supporting diagnostic tool during transurethral resection of the bladder was hexaminolevulinate (95%). Contrary to the guideline recommendation, 38% of the participants performed a second resection in the case of pTa low-grade NMIBC. Correct monitoring of Bacille Calmette-Guérin (BCG) response with cystoscopy and cytology was performed by only 34% of the urologists.

Conclusions: We found a discrepancy between certain guideline recommendations and daily routine practice concerning the use of urine cytology for initial diagnostics, instillation therapy with a low monitoring rate of BCG response, and follow-up care with unnecessary second resection after pTa low-grade NMIBC in particular. Our survey showed a moderate overall adherence rate of 73%. These results demonstrate the need for sharpening awareness of German guideline recommendations by promoting more intense education of urologists to optimize NMIBC care thus decreasing morbidity and mortality rates.

Keywords: Bladder cancer; Guideline adherence; Nonmuscle invasive bladder cancer; Survey; Treatment management.

MeSH terms

Administration, Intravesical
BCG Vaccine / therapeutic use
Humans
Neoplasm Invasiveness
Neoplasm Recurrence, Local / drug therapy
Surveys and Questionnaires
Urinary Bladder
Urinary Bladder Neoplasms* / surgery
Urology*

Substances

BCG Vaccine