The Discrepancy between the AUA Guidelines and Daily Practice in Management of Non-Muscle Invasive Bladder Cancer among Selected Group of Iraqi Urologists

Abstract

Background: Bladder carcinoma is the predominant malignancy among males and ranks fifth among females in Iraq. Non-muscle invasive bladder cancer management requires strict follow up and updated guidelines.
Objective: To assess the concordance between the current clinical practices & update guidelines for the diagnosis, treatment & follow up of non-muscle invasive bladder cancer among selected group of Iraqi urologists working in highly specialized teaching center.
Patients and methods: A prospective single center study conducted in Urology department of Al-ShahedGazi Al-Hariry Teaching Hospital for Surgical Subspecialties in one year duration from 1st of October, 2016 to 30th of September, 2017 on sample of 41 case of non-muscle invasive bladder cancer. Study questionnaire included daily practices in non-muscle invasive bladder cancer management among selected group of Urologists working in hospital with different level of certification.
Results: The results demonstrated that transuretheral resection of bladder tumor was done for all of patients with low and high risk groups, while the Re-transuretheral resection of bladder tumor was done for 40.9% of high risk group patients just. The single Mitimycin C instillation was carried out in 94.7% of low risk group and in 90.9% of high risk group, while the adjuvant Mitomycin C was carried out in 63.2% of low risk group and in 72.7% of high risk group. The intravesical Bacillus calmetteguerin and stenting were carried out only in 27.3% of high risk group patients but no patient of low risk group underwent any of these modalities of treatment.
Conclusion: There is good concordance in the daily practice of selected urologists regarding management of low risk group of non-muscle invasive bladder cancer patient with the guidelines, but poor concordance regarding high risk group.

Keywords: Non-Muscle Invasive Bladder Cancer, Management, Guidelines, AUA