title: National practice patterns for immediate postoperative instillation of chemotherapy in nonmuscle invasive bladder cancer.
abstract: OBJECTIVE
  We assessed the use of intravesical postoperative chemotherapy among United States urologists in patients with nonmuscle invasive bladder cancer.
  
  
  METHODS
  A national sample of United States based urologists (259) retrospectively assessed their practice patterns involving intravesical postoperative chemotherapy after transurethral resection in patients with nonmuscle invasive bladder cancer. These urologists reviewed the medical records of their last 4 patients with nonmuscle invasive bladder cancer, and completed a case report form for specific demographic, pathological and treatment information. Selection criteria included the pathological and patient factors of histologically confirmed diagnosis of nonmuscle invasive bladder cancer-transitional cell carcinoma, completion of initial treatment plan with ongoing observation, candidate for or recipient of intravesical therapy, and no ongoing initial intravesical induction therapy.
  
  
  RESULTS
  Overall the participation rate among those sampled was 61%. Of the 1,010 eligible patients with nonmuscle invasive bladder cancer 59.6% received instillation therapy during the initial treatment, of whom 28.4% (16.9% of patients overall) received intravesical postoperative chemotherapy. Primary, low risk patients most often received intravesical postoperative chemotherapy and 90.4% of the time patients received immediate instillation within 12 hours of surgery. However, of the urologists surveyed 66% never used intravesical postoperative chemotherapy, 17% used intravesical postoperative chemotherapy half (50%) of the time and only 2% used intravesical postoperative chemotherapy all (100%) of the time.
  
  
  CONCLUSIONS
  Wide variation in the use of intravesical postoperative chemotherapy exists among urologists in the United States. The reason for the great diversity in the use of intravesical postoperative chemotherapy is speculative. However, physician awareness, physician bias, recurrence risk, and local pharmacy and hospital practice factors are all likely contributing factors.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee, USA. mgoefelein@gmail.com
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Michael G
authors.initials: MG
authors.lastname: Oefelein
authors.forename: Jack R
authors.initials: JR
authors.lastname: Gallagher
authors.forename: Brent
authors.initials: B
authors.lastname: Schwartz
authors.forename: Kylee
authors.initials: K
authors.lastname: Heap
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011184:Postoperative Period; D010818:Practice Patterns, Physicians'; D012008:Recurrence; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D014572:Urology / Q000592:standards