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

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

^*Corresponding author for this work

2 Citations (Scopus)

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.

Original language	English
Journal	Urologia Internationalis
Volume	107
Issue number	1
Pages (from-to)	35-45
Number of pages	11
ISSN	0042-1138
DOIs	https://doi.org/10.1159/000518166
Publication status	Published - 01.01.2023

Research Areas and Centers

Research Area: Luebeck Integrated Oncology Network (LION)

DFG Research Classification Scheme

2.22-14 Hematology, Oncology
2.22-23 Reproductive Medicine, Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1159/000518166

Cite this

Struck, J. P., Hennig, M. J. P., Hupe, M. C., Moharam, N., Paffenholz, P., Nestler, T., Frank, T., Worst, T. S., Grabbert, M., Pohlmann, P. F., Dogan, S., Hofbauer, S. L., Kalogirou, C., Mattigk, A., Brandt, M. P., Krabbe, L. M., Reis, H., Dressler, F. F., Kramer, M. W., & Salem, J. (2023). Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey. Urologia Internationalis, 107(1), 35-45. https://doi.org/10.1159/000518166

@article{5fca2d8b4a914f7688227f9458cdbc26,

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

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-Gu{\'e}rin (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.",

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

year = "2023",

month = jan,

day = "1",

doi = "10.1159/000518166",

language = "English",

volume = "107",

pages = "35--45",

journal = "Urologia Internationalis",

issn = "0042-1138",

publisher = "S. Karger AG",

number = "1",

}

Struck, JP, Hennig, MJP, Hupe, MC, Moharam, N, Paffenholz, P, Nestler, T, Frank, T, Worst, TS, Grabbert, M, Pohlmann, PF, Dogan, S, Hofbauer, SL, Kalogirou, C, Mattigk, A, Brandt, MP, Krabbe, LM, Reis, H, Dressler, FF, Kramer, MW & Salem, J 2023, 'Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey', Urologia Internationalis, vol. 107, no. 1, pp. 35-45. https://doi.org/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. / Struck, Julian P.; Hennig, Martin J.P.; Hupe, Marie C. et al.
In: Urologia Internationalis, Vol. 107, No. 1, 01.01.2023, p. 35-45.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer

T2 - Results of a Binational Survey

AU - Struck, Julian P.

AU - Hennig, Martin J.P.

AU - Hupe, Marie C.

AU - Moharam, Nadim

AU - Paffenholz, Pia

AU - Nestler, Tim

AU - Frank, Tanja

AU - Worst, Thomas S.

AU - Grabbert, Markus

AU - Pohlmann, Philippe Fabian

AU - Dogan, Serkan

AU - Hofbauer, Sebastian L.

AU - Kalogirou, Charis

AU - Mattigk, Angelika

AU - Brandt, Maximilian P.

AU - Krabbe, Laura Maria

AU - Reis, Henning

AU - Dressler, Franz F.

AU - Kramer, Mario W.

AU - Salem, Johannes

PY - 2023/1/1

Y1 - 2023/1/1

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85135731277

U2 - 10.1159/000518166

DO - 10.1159/000518166

M3 - Journal articles

C2 - 34515257

AN - SCOPUS:85135731277

SN - 0042-1138

VL - 107

SP - 35

EP - 45

JO - Urologia Internationalis

JF - Urologia Internationalis

IS - 1

ER -

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

Abstract

Research Areas and Centers

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UN SDGs

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