Evidence-based care in urology: The future is now

The AUA's "Guideline for the Management of Nonmuscle Invasive Bladder Cancer," published in 2007, recommends as a standard repeat resection prior to additional therapy in patients with stage T1 bladder cancer but without muscularis propria in the specimen. University of North Carolina researchers performed a 4-year retrospective review of 556 transurethral bladder tumor resections to address the utility of the recommended re-resection. They reported on 56 re-resections for patients originally staged as T1 and found 15 patients had no muscle in the original specimen and 41 had muscle present. At re-resection, 30% had no residual disease, 21% had less than T1 disease, 39% had T1 disease, and 9% had T2 disease.

The authors substantiated the recommendations of the guideline panel and found that re-resection not only provided more accurate staging and complete resection, but also provided valuable information for determining further treatment.

In this era of ever-increasing pressure to meet quality standards, it behooves us as a specialty to not only read but to follow our evidence-based guidelines. Experts in every subspecialty of urology have spent countless hours reviewing the available literature and providing guidance in the management of our patients. The guidelines are available free of charge at http://www.auanet.org/guidelines/.

By practicing evidence-based urology and eliminating as much variance as possible, we elevate the quality of urologic care and our patients are the greatest beneficiaries.

J. Brantley Thrasher, MD a Urology Times editorial consultant, is professor and chair of urology, University of Kansas Medical Center, Kansas City.