Comparative Analysis of Gender-Related Differences in Symptoms and Referral Patterns prior to Initial Diagnosis of Urothelial Carcinoma of the Bladder: A Prospective Cohort Study

Abstract

Objective: To analyze gender-specific differences regarding clinical symptoms, referral patterns and tumor biology prior to initial diagnosis of urothelial carcinoma of the bladder (UCB). Methods: A consecutive series of patients with an initial diagnosis of UCB was included. All patients completed a questionnaire on demographics, clinical symptoms and referral patterns. Results: In total, 68 patients (50 men, 18 women) with newly diagnosed UCB at admission for transurethral resection of bladder tumors were recruited. Dysuria was more often observed in women (55.6 vs. 38.0%, p = 0.001). Direct consultation of the urologist was conducted by 84.0% of males and 66.7% of females (p = 0.120). One third of the women saw their general practitioner and/or gynecologist once or twice (p = 0.120) before referral to the urologist. Furthermore, women were significantly more often treated for urinary tract infections than men (61.1 vs. 20.0%, p = 0.005). Cystoscopy at first presentation to the urologist was more often performed in men than women (88.0 vs. 66.7%, p = 0.068), with a more favorable tumor detection rate at first cystoscopy in men (96.0 vs. 50.0%, p < 0.001). Conclusions: Delayed referral patterns might lead to deferred diagnosis of UCB and consequently to adverse outcome. Thus, primary care physicians might consider referring patients with bladder complaints to specialized care earlier.

Sex Differences of ≥pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients

“…Women were more often treated for urinary tract infection and were given symptomatic treatment without further clinical evaluation more frequently than men before being referred to an urologist [11]. Similar data have recently been reported by Aziz et al using the same questionnaire developed by Henning et al [11,12]. These data suggest that an unequal referral pattern might indeed be - at least partly - responsible for the higher tumour stages in women at initial diagnosis [10].…”

The Impact of Gender on Tumour Stage in In-House Complications and Choice of Urinary Diversion: Results of the Austrian Cystectomy Registry

“…Less than half of the women compared to 81% of the men directly consulted an urologist for haematuria [18]. These data suggest an unequal referral pattern that might be -at least partly -responsible for the higher tumour stages of women at initial diagnosis [2,[17][18][19]. Gender differences in perioperative complications following RC are also of interest and concern.…”

Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes

“…Two European studies based on health systems that allow for direct self-referral to a specialist Urology service found that 78 versus 55% [5] and 84.0 versus 66.7% [6] of men and women, respectively, self-referred. This raises the possibility of a gender difference not only in terms of appreciation of significance of symptoms but also different attitudes toward accessing specialist healthcare that is in contrast to the traditional view of men displaying more risk-taking behavior and an aversion to seeking medical attention.…”

“…Women are more likely to have urinalysis and culture sent and more likely to be diagnosed with a UTI (33.1 vs. 17.6%, p < 0.001) [11] (61.1 vs. 20.0, p = 0.005) [6]. Cohn et al [11 ]also found that women were more likely to receive 3 or more courses of antibiotics than male patients prior to their bladder cancer diagnosis (8.7 vs. 5.2%, p < 0.001).…”