RNs should undertake appropriate skill development in pre-registration programmes and be provided with preceptorship to ensure they are equipped adequately to supervise and delegate work to HCAs.

Objective. Diagnostic reliability of prenephroureterectomy ureteroscopy (PNU) for the detection of upper tract carcinoma in situ (CIS) remains unproven in particular and underreported in general. Methods. Patients who underwent radical nephroureterectomy (RNU) in a large multicentre retrospective study for upper tract transitional cell carcinoma (UT-TCC) between January 2002 and December 2013 were identified from our hospitals databases. PNU appearances, stage, and grade of ureteroscopic biopsy were compared with final histology results of RNU to assess the diagnostic reliability of PNU for carcinoma in situ (CIS). Results. Three hundred patients underwent RNU for UT-TCC. 106 (106/300; 35.3%) of the cohort had PNU using white light with biopsies taken in most (92/106; 86.7%). Postnephroureterectomy histology of the cohort showed CIS in 65 (65/300; 21.6%) patients. Thirty nine of patients with CIS (39/65; 60%) had prenephroureterectomy ureteroscopy biopsies. Out of ten patients with CIS on ureteroscopic biopsies, six did not show CIS on final histopathology (6/10; 60%). Moreover, grading and staging on PNU biopsies of obvious tumours showed a significant nonconcordance with final histopathology of RNU specimen (P = 0.02). Overall survival was also shorter in patients with CIS compared with those without; this showed strong statistical significance (P = 0.004). Conclusions. There is a high incidence of CIS in upper tract with significant underdetection and discordance rate between the histopathology of biopsy samples obtained by white light PNU and resected specimen of radical nephroureterectomy. The presence of concomitant CIS and high stage disease in the upper tract TCC carried a poor prognosis following radical nephroureterectomy.

Since the turn of the 20th century Bacillus Calmette‐Guerin (BCG) treatment for non‐muscle invasive bladder cancer (NMIBC) has been in and out of favour. However, only a small proportion of patients, as low as 16%, complete what is seen as a gold standard treatment. To understand why it is the gold standard treatment the epidemiology and aetiology of NMIBC is presented. This article discusses how BCG was first discovered in cows to it being used as a treatment for NMIBC. The issues of side effects which can be from mild to severe and local to systemic, will be discussed. The impact of age in the tolerance of this treatment will be also be looked at. In conclusion, with BCG treatment being the preferred option for NMIBC, it also comes with significant side effects. It is these that should be of concern to the health care professional as they can be potentially life threatening.

Research question: The aim of this study is to explore how the patient's experience of their treatment influence withdrawal from BCG? And what are the strategies that could reduce patient withdrawal from BCG treatment? Research problem: The cumulative treatment side effects of Bacillus Calmette-Guerin can be both physical and psychological. Bladder cancer accounts for over 10 000 new diagnosis annually in the United Kingdom. Therefore, this article attempts to explore the patient's experience of their treatment and how this influences their withdrawal from treatment. Literature review: A literature review was undertaken utilizing the CONSORT approach for reporting of research trials. Multiple databases were searched. The review showed that there is a paucity in the literature in the comprehensive understanding of the patient's experience of undertaking BCG treatment and potential subsequent withdrawal. Methodology: A qualitative data was collected using semi-structured interviews. Six interviews were conducted on participants who withdrew from intravesical BCG treatment. An inductive approach was used to thematically analyse the data. Results: NVivo 10 was used to manage the data. Following an in-depth analysis of the interview transcripts when all available data had been extracted and coded, four key themes emerged. These four themes were identified as: "treatment concerns"; "withdrawal influencers"; "unmet needs"; and what appeared to be "treatment bereavement" were concerning to the participants. Conclusions: This article presents the results from the qualitative phase of a larger mixed methods study. The data produced from the interviews highlights themes and factors that cause patients to withdraw from BCG treatment early. These areas show the requirement for additional support in areas of communication, information giving and decision making. This study also identified a "novel" concept of "treatment bereavement", which described the feelings of loss when withdrawing early.