title: Differences between urologists in United States and Canada in approach to bladder cancer.
abstract: OBJECTIVE
  To determine the Canada-United States differences with respect to the detection, diagnosis, surveillance, and treatment of bladder cancer.
  
  
  METHODS
  A multiple-choice questionnaire was developed and mailed to 760 American and 516 Canadian urologists between November and December 2002. The areas assessed by the questionnaire included demographics, screening, superficial disease and recurrence, surveillance, muscle-invasive disease, advanced disease, and adjuvant systemic chemotherapy.
  
  
  RESULTS
  The survey was adequately completed by 32.3% of American urologists and 40.0% of Canadian urologists (overall response rate 36.2%). Canadian urologists tended to be older and had larger practices than U.S. urologists (P <0.05). With respect to bladder cancer detection, U.S. urologists were more likely to use intravenous urography and cystoscopy than were Canadian urologists (P <0.0001). For patients with superficial disease, a significant proportion of urologists in both countries did not routinely use adjuvant chemotherapy. For surveillance, Canadian urologists performed cystoscopy (P <0.0001) and upper tract imaging (P <0.0001) less frequently than U.S. urologists. Striking differences were noted in the approach to Stage T2a disease, with U.S. urologists advocating radical cystectomy more frequently (P <0.0001). With respect to the type of urinary diversion, Canadian urologists tended to favor conduits (P <0.0001, male and P = 0.002, female). Canadian urologists were also less likely to use adjuvant chemotherapy among patients with advanced disease.
  
  
  CONCLUSIONS
  The results of our study have shown that the trend of urologists in the United States is toward more aggressive screening, closer surveillance, an earlier trigger for cystectomy, and more common indications for intravenous chemotherapy.
authors.affiliation: Department of Surgery, Division of Urology, Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Doreen
authors.initials: D
authors.lastname: Chung
authors.forename: Karen
authors.initials: K
authors.lastname: Hersey
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D002278:Carcinoma in Situ; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000628:therapy*; D014572:Urology