title: 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.
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.forename: Evi
authors.initials: E
authors.lastname: Comploj
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
mesh_terms: D000368:Aged; D001317:Austria; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003558:Cystoscopy / Q000639:trends; D053159:Dysuria / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D058005:General Practitioners / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation / Q000639:trends*; D012307:Risk Factors; D012737:Sex Factors; D013038:Specialization / Q000639:trends; D011795:Surveys and Questionnaires; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019459:Urothelium / Q000473:pathology* / Q000601:surgery