title: Intravesical therapy use in the high risk patient: practice patterns in an equal access healthcare institution before and after national guidelines.
abstract: OBJECTIVE
  We examined patterns of intravesical therapy use in nonmuscle invasive bladder cancer over the last 10 years at our institution where there is equal access to healthcare. We further examined any affect that the introduction of national guidelines may have had on the utilization of intravesical therapy in these patients.
  
  
  METHODS
  An Institutional Review Board (IRB) approved retrospective chart review was performed between the years 1997 and 2007. Only those with premalignant or malignant pathology, as identified using intradepartmental surgical logs and pathology reports, were included.
  
  
  RESULTS
  Four hundred seventeen procedures, representing 228 patients, were identified that met the above criteria. A total of 170 high risk, nonmuscle invasive bladder tumors (HG, CIS and T1) were identified, or 41% of cases in whom intravesical therapy was indicated according to the 1999 American Urological Association (AUA) guidelines. One hundred nine (64.2%) received intravesical therapy and 61 (35.8%) did not. This corresponds to an underutilization rate of 19.4% (33/170 high risk tumors did not receive intravesical therapy for unknown reasons).
  
  
  CONCLUSIONS
  We have determined that the utilization of intravesical therapy in patients with high risk nonmuscle invasive bladder cancer has improved since the introduction of the 1999 AUA guidelines in an equal access healthcare institution and that patients are compliant with this therapy.
authors.affiliation: Department of Surgery, Urology Service, Madigan Army Medical Center, Tacoma, Washington 98431, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Pugliese
authors.forename: Richard N
authors.initials: RN
authors.lastname: Greene
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000627:therapeutic use; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000627:therapeutic use; D001706:Biopsy; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine