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Objective We report NHS England data for patients with bladder cancer (BC), upper tract urothelial cancer (UTUC: renal pelvic and ureteric), and urethral cancers from 2013 to 2019. Materials and Methods Hospital episode statistics, waiting times, and cancer registrations were extracted from NHS Digital. Results Registrations included 128 823 individuals with BC, 16 018 with UTUC, and 2533 with urethral cancer. In 2019, 150 816 persons were living with a diagnosis of BC, of whom 113 067 (75.0%) were men, 85 117 (56.5%) were aged >75 years, and 95 553 (91.7%) were Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100 000 population). Most patients 52 097 (mean [range] 41.3% [40.7-42.0%]) were referred outside the 2-weekwait pathway and 15 340 (mean [range] 12.2% [11.7-12.6%]) presented as emergencies. Surgery, radiotherapy, chemotherapy, or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27% and 29% (n = 6616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location, and tumour histology. Overall survival rates did not improve over time (relative change: 0.97, 95% confidence interval 0.97-0.97) at 2 years in contrast to other cancers. Conclusion The diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use of radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete. [ABSTRACT FROM AUTHOR]

Objective: To understand the barriers and facilitators to single instillation of intravesical chemotherapy (SI‐IVC) use after resection of non‐muscle‐invasive bladder cancer (NMIBC) in Scotland and England using a behavioural theory‐informed approach. Subjects and Methods: In a cross‐sectional descriptive study of practices at seven hospitals, we investigated care pathways, policies, and interviewed 30 urology staff responsible for SI‐IVC. We used the Theoretical Domains Framework (TDF) to organise our investigation and conducted deductive thematic analyses, while inductively coding emergent beliefs. Results: Barriers to SI‐IVC were present at different organisational levels and professional roles. In four hospitals, there was a policy to not instil SI‐IVC in theatre. Six hospitals' staff reported delays in mitomycin C (MMC) ordering and/or local storage. Lack of training, skills and perceived workload affected motivation. Facilitators included access to modern instilling devices (four hospitals) and incorporating reminders in operation proforma (four hospitals). Performance targets (with audit and feedback) within a national governance framework were present in Scotland but not England. Differences in coordinated leadership, sharing best practices, and disliking being perceived as underperforming, were evident in Scotland. Conclusions: High‐certainty evidence shows that SI‐IVC, such as MMC, after NMIBC resection reduces recurrences. This evidence underpins international guidance. The number of eligible patients receiving SI‐IVC is variable indicating suboptimal practice. Improving SI‐IVC adherence requires modifications to theatre instilling policies, delivery and storage of MMC, staff training, and documentation. Centralising care, with bladder cancer expert leadership and best practices sharing with performance targets, likely led to improvements in Scotland. National quality improvement, incorporating audit and feedback, with additional implementation strategies targeted to professional role could improve adherence and patient outcomes elsewhere. This process should be controlled to clarify implementation intervention effectiveness. [ABSTRACT FROM AUTHOR]

Shortages of Bacille Calmette‐Guérin (BCG) have implications for the management of patients with non‐muscle‐invasive bladder cancers. Further complications come as a result of COVID‐19 for which BCG also shows some promising prospects. [ABSTRACT FROM AUTHOR]

Aim: This narrative review describes current guidelines for treating NMIBC, provides an overview of the principle behind immune checkpoint inhibition, and summarizes current evidence for checkpoint inhibitors in urothelial malignancy. Further, we discuss potential strategies for immune checkpoint inhibition in the management of NMIBC. Background: Adjuvant intravesical BCG immunotherapy has been the mainstay of treatment for high‐risk non‐muscle‐invasive bladder cancer (NMIBC) for decades but is associated with both a significant side effect profile and failure rate. Recently, a substantial body of trial data has been published demonstrating the successful use of systemic immunotherapy in the treatment of advanced urothelial malignancy and, in particular, a class of drugs known as 'immune checkpoint inhibitors'. This has led to the approval of a number of these drugs by the UK National Institute of Health and Care Excellence and the US Food and Drug Administration, and ongoing trials are examining use in the management of NMIBC. Methods: To identify relevant published data, using the PubMed/ Medline search engine, an online search of the Pubmed/ Medline archives was conducted using the terms bladder cancer' in combination with 'checkpoint inhibitors', and limited to articles in English published between 1966 and September 2017.To identify ongoing trials of interest but not yet published, a further search of the clinical trials.gov search engine was conducted using the term 'non‐muscle‐invasive bladder cancer'. Conclusion: There has been little advance in available adjuvant therapy for NMIBC treated with TURBT. Current intravesical therapies are associated with a high recurrence rate and significant side effect profile. The impending publication of the wealth of ongoing trials, both into the delivery and efficacy of checkpoint inhibition will direct the future treatment of NMIBC. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. Patient and methods: The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub‐analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. Results: Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3–33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High‐risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high‐risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow‐up. Conclusions: Urine cytology will miss a significant number of muscle‐invasive bladder cancer and high‐risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia. [ABSTRACT FROM AUTHOR]

The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow‐up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity. [ABSTRACT FROM AUTHOR]

Although there has been an overall reduction in the incidence of bladder cancer, the mortality rate has remained unchanged, hence survival is now worse. Most patients have non-muscle-invasive bladder cancer at presentation, which is not immediately life threatening, so efforts must be made to improve the early diagnosis and expeditious treatment of this disease. [ABSTRACT FROM AUTHOR]

The authors discuss aspects of transurethral resection for bladder tumour (TURBT). They say that TURBT is the most common surgical operation for urological cancer with 39,331 procedures performed in Great Britain alone in 2009. They add that the four TURBT aims include papillary tumours identification within the bladder, the complete removal of tumours, and identify dysplasia or carcinoma in situ (CIS) areas in the bladder.

The article offers information on the importance of haematuria clinic. It mentions the recent study which reveals that haematuria clinic is fit for purpose as 19 percent of patients with macroscopic haematuria investigated will have bladder cancer. It discusses the role on the use of urothelian cancer (UC) and urinary tumor markers in haematuria clinic.

The article focuses on the role of photodynamic diagnosis (PDD) in detecting non-muscle-invasive bladder cancer. According to the findings of the European Association of Urology (EAU), the use of PPD plays a significant role in the detection of malignant tumours as it reduces residual tumour rates by at least 20%. Moreover, the quality of life of patients assessed and treated with PDD reduces anxiety for it provides more accurate diagnosis and reduces risk of cancer recurrence.

Non-muscle-invasive bladder cancers form a heterogeneous group of tumours with varying recurrence and progression rates. Recently low-, intermediate- and high-risk categories, based on tumour stage and grade, have been used to predict prognosis and guide treatment. Whilst the therapeutic options for the low- and high-risk groups are well defined, the optimal treatment for patients in the intermediate-risk group is unknown. We review current treatment options, recent advances and future developments in the treatment of patients with intermediate-risk non-muscle-invasive bladder cancer. [ABSTRACT FROM AUTHOR]

Recent NICE guidance says there is limited evidence for the efficacy of transurethral laser ablation for recurrent non‐muscle invasive bladder cancer and that 'special arrangements' need to be in place if it is to be offered to patients. Here the authors consider the advantages and drawbacks of the treatment. [ABSTRACT FROM AUTHOR]

To assess a modified technique of multidetector computed tomographic urography (CTU) which can reproducibly and accurately map the pelvicalyceal system (PCS) and complex renal calculi, as such information is essential in choosing the optimal percutaneous approach into the PCS for safe and successful percutaneous nephrolithotomy (PCNL). Ten consecutive patients with renal calculi underwent a modified four-detector multislice CTU with frusemide, abdominal compression and subsequent injection with contrast medium. After unenhanced CT of the abdomen, a high-resolution contrast-enhanced scan was taken through the kidneys in the pyelographic phase. Data were analysed using multiplanar reconstruction and three-dimensional (3D) reformatting. In 10 CTUs there were three staghorn, two diverticular, 25 calyceal, two infundibular and two renal pelvic calculi; nine showed posterior calyces and good infundibular anatomy, and provided a good map of the PCS. Seven patients had PCNL, with the remaining three having either primary extracorporeal shock wave lithotripsy or conservative management. CTU detected stones in all patients and accurately located their relation to the PCS. With reconstructed images, subjectively the 3D imaging provided an advantage over conventional imaging in optimizing nephrostomy placement. CTU with this protocol and post-processing techniques enables an accurate and confident, reproducible prediction of the site, number and size of stones in complex pelvicalyceal anatomy, optimal site(s) for placing the percutaneous track, and potential hazards when placing the track, with no significant increase in the patient's radiation burden. 3D CTU should become the standard imaging method for planning PCNL in selected patients. [ABSTRACT FROM AUTHOR]

In this article, the author comments on a randomized controlled trial about maintaining intravesical bacillus Calmette-Guérin (BCG) regime through instillations of BCG Tokyo strain.

The article presents a study which compares white-light cystoscopy (WLC) and fluorescence cystoscopy (FC), using hexaminolaevulinate (HAL), in the detection of non-muscle-invasive bladder cancer (NMIBC) and recurrence rate after transurethral resection of bladder tumour (TURBT). It notes that a multicentre prospective randomized trial was conducted on patients with NMIBC. Results show that HAL FC demonstrates an improvement in recurrence-free survival.

A letter to the editor and a reply are presented in response to an article on the increase in the median age of the bladder cancer population reflecting the ageing population.