Assessment and management of haematuria in the general practice setting.

BACKGROUND: The presence of haematuria may be a singular symptom signalling underlying urological pathology, either benign or malignant. However, a large proportion of patients with haematuria will have no identifiable cause found. Appropriate early investigation and management of haematuria in the primary care setting is important for timely referral of patients suspected of having serious underlying pathology while avoiding over-investigation in those patients prone to transient and benign causes. OBJECTIVE: The aim of this article is to provide a summary of the aetiology, investigation and management of haematuria in the primary care setting, with a focus on urological assessment and outcomes. DISCUSSION: The approach to the diagnosis and investigation of haematuria differs depending on whether the haematuria is macro- or microscopic. In both cases, clinicians should begin by obtaining a careful patient history to include specific risk factors for urological malignancy, as often the decision for further work-up requires a risk-stratified approach.

Utility of lymphadenectomy following cystectomy for non-urothelial bladder cancer: a systematic review.

INTRODUCTION: Non-urothelial bladder cancer patients represent a rare and challenging group. Advances in bladder cancer to date have largely been driven by studies investigating common urothelial bladder tumors. New evidence is emerging supporting lymphadenectomy in standard surgical management of muscle invasive bladder cancer. We aim to explore the utility of lymphadenectomy in non-urothelial bladder cancer. EVIDENCE ACQUISITION: A systematic review of the available peer-reviewed literature on PubMed was performed using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search strategy. Tumors included in our analysis were squamous cell carcinomas, adenocarcinomas, paragangliomas, melanomas and sarcomas. EVIDENCE SYNTHESIS: Our search strategy identified 8168 unique records and we included 135 full text articles in our final qualitative analysis. No comparative studies comparing lymphadenectomy outcomes in non-urothelial bladder tumors were identified. Practice of lymphadenectomy in combination with partial or radical cystectomy in the treatment of non-urothelial bladder cancer is relatively common. Pelvic recurrence following radical or partial cystectomy of non-urothelial tumors was more commonly reported in non-lymphadenectomy cohorts. The exception to this observation was the adenocarcinoma cohort. CONCLUSIONS: Current evidence supporting lymphadenectomy in the surgical management of bladder cancer is largely based on studies limited to urothelial cancer. Despite this, the practice of lymphadenectomy in non-urothelial cancer is common. We support lymphadenectomy in non-urothelial bladder cancer given the minimal risk associated with the procedure and the potential for improved survival.

Bladder Cancer Patient Advocacy: A Global Perspective.

Over the past 20 years, cancer patient advocacy groups have demonstrated that patient engagement in cancer care is essential to improving patient quality of life and outcomes. Bladder cancer patient advocacy only began 10 years ago in the United States, but is now expanding around the globe with non-profit organizations established in Canada, the United Kingdom and Italy, and efforts underway in Australia. These organizations, at different levels of maturity, are raising awareness of bladder cancer and providing essential information and resources to bladder cancer patients and their families. The patient advocacy organizations are also helping to advance research efforts by funding research proposals and facilitating research collaborations. Strong partnerships between these patient advocates and the bladder cancer medical community are essential to ensuringsustainability for these advocacy organizations, increasing funding to support advances in bladder cancer treatment, and improving patient outcomes.