The economic benefit of photodynamic diagnosis in non-muscle invasive bladder cancer.

Non-muscle invasive bladder cancer is the most expensive cancer to manage on a per patient basis due to the high recurrence rate, low mortality and the need for long term, often lifelong surveillance. Current white-light endoscopic surgery leads to a significant number of patients having "recurrent" cancer at their first follow-up cystoscopy. The introduction of a single dose of intravesical chemotherapy immediately after the initial resection has helped to reduce the recurrence rate but it can be toxic and should not be administered to patients with potential bladder perforations after transurethral resection of bladder tumour (TURBT). Photodynamic diagnosis cystoscopy has been shown to significantly improve the quality of the initial TURBT leading to a 20% reduction in tumour recurrences at 3 months. This benefit is sustained for at least 8 years, leading to a reduction in further invasive procedures and treatment. Despite the initial increased cost related to introducing a photodynamic diagnosis service there is clearly long-term significant cost savings to be made, as well as improving the patient experience and quality of life.

Outcome following TVT sling procedure: a comparison of outcome recorded by surgeons to that reported by their patients at a London district general hospital.

OBJECTIVE: Retrospective study to assess patient satisfaction rates after TVT sling procedure for stress urinary incontinence (SUI), and comparison of these results to the post-operative progress documented by the surgeons in the clinical notes. METHODS: All TVT sling cases at our institution during February 1999 to December 2002 were included. Data was collected from clinical notes on post-operative outcome as recorded by the surgeons, and a patient satisfaction questionnaire was used to assess patients' perception of their progress. RESULTS: The response rate to the patient satisfaction questionnaire was 72%. Overall 94% of the patients were satisfied with the procedure. However, they reported cure rates of only 44%. This is comparable to the 46% cure rates documented by the surgeons. CONCLUSION: The surgeons' and the patients' perceptions regarding outcome and change in symptoms after TVT sling for SUI at our hospital, correlate well. Hence, the documentation in the clinical notes by the surgeons can be relied upon as an accurate representation of post-operative patient progress. Despite the relatively low cure rates (44-46%) for SUI with TVT sling procedure, the patient satisfaction rates with the outcome are high (94%), reiterating that there is a poor correlation between quality of life impairment and the concept of cure.