Bladder oncology clinics: Do they really work?.

Background and objectives The majority of bladder cancers diagnosed in Australia are non-muscle invasive bladder cancers (NMIBC). We recently established a dedicated haematuria and postoperative bladder oncology clinics with the aim to fast track diagnosis and treatment for newly diagnosed bladder cancers. In this study, we have assessed whether the new service was adhering to the European Association of Urology (EAU) guidelines for the management of NMIBC. Materials and methods Retrospective data collection for patients with primary NMIBC diagnosed between the 1st of July 2015 till 30th of June 2017 at our Victorian Public hospital. All recurrent tumours were excluded. We utilized all patient files and our hospital pathology database. Results 349 patients were diagnosed with primary NMIBC (265 males, 84 females, mean age 54). 177 (51%) patients were diagnosed with Ta tumours, 118 (34%) with T1 tumours and 54 (15%) patients with carcinoma in situ (CIS). 7 (4%) patients with Ta disease received a single immediate post-operative instillation of MMC. All patients with Ta disease were referred to a flexible cystoscopy surveillance program, 3 (0.86%) were lost to follow-up. 140 (81.4%) High Grade disease patients were referred to our BCG clinic, 2 (1.2%) were referred directly for a radical cystectomy, 30 (17.4%) were deemed inappropriate for BCG therapy and referred for surveillance. Of the 140 who were referred for BCG, 130 (92.9%) patients received full induction course. Only 49 (35.0%) patients went on to receive the full maintenance course. Conclusion Our study has illustrated that the majority of our highgrade disease patients received induction BCG, however few progressed to have the recommended maintenance course. Reasons included patient, clinician, and hospital factors. The vast majority of our low-grade tumour patients did not receive the recommended immediate intravesical chemotherapy. This demonstrates that we are not currently adhering to the current level