British urological surgery practice: 2. Renal, bladder

Abstract

Objective To investigate the management of urological malignancies in the United Kingdom. Methods A postal survey of consultant urologists and general surgeons with an interest in urology was conducted to examine current clinical practice in urological malignancies. Results Completed questionnaires were received from 273 consultant surgeons who saw an estimated total of 13 241 new patients with renal, bladder or testis cancer per year; 82% had access to on‐site oncology services and in general there was a consensus in the answers given. Most respondents advised active treatment of an asymptomatic primary renal cancer in the presence of metastases and a significant proportion of patients with metastases were not prescribed immunotherapy nor were offered a multidisciplinary approach for their condition. Forty‐six per cent of patients with testis cancer received no advice to store sperm before chemotherapy and there were varied opinions as to the need for surgical resection of residual masses after completion of chemotherapy. Conclusion This survey showed minor variations in the management of renal, bladder and testis tumours in the UK. Consensus management guidelines for urological malignancies and a change in the working relationships between urologists and oncologists is required, to improve the outcome of patients with urological malignancy.

The Association Between Testis Cancer and Semen Abnormalities Before Orchiectomy: A Systematic Review

“…A study in the United Kingdom found that only 54% of urologists there routinely offered sperm banking before orchiectomy. 18 Most studies have recommended sperm banking before adjuvant therapy (chemotherapy or radiation), as these treatments have been shown to be associated with severe semen abnormalities. 4,5 The sperm retrieved can be used in different assisted reproductive methods for fertility with a high chance of success (pregnancy rate up to 30% per egg collection 19 ).…”

Changing Attitudes to the Management of Muscle Invasive Bladder Cancer—A Postal Survey of UK Urologists

“…Two thirds of UK urologists who responded to this survey are now doing radical cystectomy for muscle invasive bladder cancer themselves and others refer suitable patients to colleagues for this treatment modality. This is a major shift from previous practice when radiotherapy was favoured [1]. There has recently been emerging reports of a resurgence in bladder preserving treatments with chemo-radiotherapy after trans-urethral resection of tumour but it is too early to tell if this will gather momentum and more importantly, be sustained [11].…”

“…The latter is treated by either radical cystectomy by most urologists around the world when the disease is organ-confined and no co-morbidities exist or by radiotherapy when the patient either chooses this modality of treatment, disease is not organconfined or significant co-morbidities preclude major surgical intervention. In the United Kingdom, radiotherapy was the favoured way of treatment for muscle invasive bladder cancer [1]. However, over the last 10 years there appears to have been a gradual shift from this approach in favour of radical cystectomy.…”

Is surveillance for stage 1 germ cell tumours of the testis appropriate outside a specialist centre?

“…The incidence of testis cancer is increasing [ 1] but there is still no universal agreement for the management of stage 1 disease. A recent survey of urology consultants [ 2] revealed that 67% would treat clinical stage 1 (CS1) seminoma by radiotherapy, 25% by observation and 7% by chemotherapy, and that 60% would chose observation for CS1 teratoma, 35% chemotherapy and 5% radiotherapy. These data do not reflect practice, as most patients after orchidectomy are managed by oncologists, but it does highlight the differing opinions amongst urologists.…”

“…In the absence of The incidence of testis cancer is increasing [1] but there is still no universal agreement for the management of eCective salvage treatment for recurrent disease, all CS1 testis tumours received adjuvant treatment after orchi-stage 1 disease. A recent survey of urology consultants [2] revealed that 67% would treat clinical stage 1 (CS1) dectomy, i.e. modest doses of radiotherapy for seminomas and either radiotherapy or retroperitoneal lymph node seminoma by radiotherapy, 25% by observation and 7% by chemotherapy, and that 60% would chose obser-dissection (RPLND) for teratomas.…”