Bladder-sparing treatment in MIBC: where do we stand?

INTRODUCTION: The gold-standard treatment of muscle-invasive bladder cancer is radical cystectomy (RC), but this can be associated with morbidity and perioperative risks. Patients may not be fit for RC or choose to preserve their bladders. There are evolving bladder-sparing treatments that are often delivered in a multimodal approach. Here, we aim to review recent advances in bladder-sparing treatments. EVIDENCE ACQUISITION: We undertook a narrative review informed by a Medline/PubMed literature search using a combination of terms for recent (5 years) articles in English. Relevant studies from authors' bibliographies were retrieved. EVIDENCE SYNTHESIS: Bladder-sparing treatment consists of transurethral resection of bladder tumour (TURBT), radiotherapy and chemotherapy. Experimental approaches with immunotherapy and using gene signatures for radiation therapy and chemotherapy response are being explored. CONCLUSIONS: Bladder-sparing treatment is an option for patients with bladder cancer. Those who may benefit most are those with solitary invasive cancers, those with good bladder capacity and compliance, those who choose to preserve their bladder and sexual function and who are not fit for RC. Multimodal bladder-sparing approaches may have comparable oncological outcomes to RC and so appear an attractive alternative in suitable patients.

Neurosurgical referral service using smartphone client WhatsApp: preliminary study at a tertiary referral neurosurgical unit.

BACKGROUND: Smartphone-based clients are being increasingly used in a medical world for individual as well as group communications. The authors report the use of WhatsApp, a common social media smartphone client for neurosurgical referral service in their Institution. They extend the use of WhatsApp application from a purely intra-departmental informal communication to a formal tertiary referral service for Neurosurgical referrals. The pros and cons of deploying such system are discussed and important concerns are highlighted. METHODS: Over a period of one year, the authors record 1412 referrals to the Neurosurgical service at a tertiary referral centre using WhatsApp application. All the data gathered through WhatsApp referrals was subsequently validated and analysed for any errors. They identify eight incidences where the system did not accurately convey the intended information. They highlight the potential issues related to data accuracy and confidentiality encountered in using such a system. OBSERVATIONS: In this preliminary study, the authors consider WhatsApp application as an important tool for Neurosurgical referrals. It is safe, cheap, reliable and user-friendly application allowing seamless transfer of data including clinical videos and scan images to the on call neurosurgical team. Loss of data quality, concerns surrounding patient confidentiality, errors caused by inter-operator variability in capturing data and default prohibition of use of such social media applications in many institutions are important disadvantages in regularly using such service. CONCLUSIONS: Smartphone-based social media clients such as WhatsApp provide a promising future for faster, reliable communication of clinical and radiological data, which can be used for on-call neurosurgical referrals. Integration with PACs applications and facial recognition may facilitate increasing use of such applications in future addressing many of the concerns that currently prohibit their universal use.