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Joshua I. Warrick

Pathologists have identified many bladder cancer (BCA) histomorphologies that differ from conventional urothelial carcinoma (UC; also known as transitional cell carcinoma ). Several of these histologic variants are biologically aggressive, and

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Richard S. Matulewicz, Brendan T. Frainey, Daniel T. Oberlin, and Joshua J. Meeks

Background The current treatment paradigm for non–muscle-invasive bladder cancer (NMIBC) is directed at reducing cancer recurrence and preventing disease progression to more advanced stages. Historically, this has been accomplished through the

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Stephen A. Brassell and Ashish M. Kamat

. Jemal A Siegel R Ward E . Cancer statistics, 2006 . CA Cancer J Clin 2006 ; 56 : 106 – 130 . 2. Heney NM Ahmed S Flanagan MJ . Superficial bladder cancer: progression and recurrence . J Urol 1983 ; 130 : 1083 – 1086 . 3

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Michael R. Abern, Richmond A. Owusu, Mark R. Anderson, Edward N. Rampersaud, and Brant A. Inman

Currently, 2.4% of all people born in the United States will develop bladder cancer during their lifetime. 1 In 2012, the estimated incidence of bladder cancer was 73,510, with a 3:1 male-to-female ratio, and accounted for 14,880 deaths. 1 At

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Peter E. Clark

of this promise is in bladder cancer. Within the past 4 years, at least 4 different groups have independently tested the expression profile of locally advanced bladder cancers (typically those undergoing radical cystectomy) and assigned a molecular

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Hideki Furuya and Charles J. Rosser

“…for whom the bell tolls, It tolls for thee.” - John Donne The article, “It May be Time to Abandon Urine Tests for Bladder Cancer” 1 reinforces what is widely known within urology: that current urine-based assays for the diagnosis of

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Joseph J. Fantony and Brant A. Inman

Bladder cancer is the second most common malignancy of the genitourinary tract and fifth most common malignancy overall in the United States. 1 The current standard for diagnosis and surveillance of bladder cancer includes a combination of

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Saurabh Parasramka, Quan Chen, Bin Huang, Peng Wang, and Zin Myint

Background: Non-metastatic muscle invasive bladder cancer (MIBC) is treated with radical cystectomy and survival is closely associated with final pathologic staging. For patients undergoing primary surgery there is evidence that delay > 90 days

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Shree Vishnu Siddarth, Ginil Kumar Pooleri, and Georgie Mathew

Introduction: The recurrence following a transurethral resection (TUR) of non-muscle invasive bladder cancer (NMIBC) remains relatively high. A single immediate postoperative instillation of mitomycin C (MMC) reduces the rate of recurrence in the

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Elio Mazzone, Sophie Knipper, Francesco A. Mistretta, Carlotta Palumbo, Zhe Tian, Andrea Gallina, Derya Tilki, Shahrokh F. Shariat, Francesco Montorsi, Fred Saad, Alberto Briganti, and Pierre I. Karakiewicz

Background: Use of inpatient palliative care (IPC) in the treatment of advanced cancer represents a well-established guideline recommendation. A recent analysis showed that patients with genitourinary cancer benefit from IPC at the second lowest rate among 4 examined primary cancers, namely lung, breast, colorectal, and genitourinary. Based on this observation, temporal trends and predictors of IPC use were examined in patients with metastatic urothelial carcinoma of the bladder (mUCB) receiving critical care therapies (CCTs). Patients and Methods: Patients with mUCB receiving CCTs were identified within the Nationwide Inpatient Sample database (2004–2015). IPC use rates were evaluated in estimated annual percentage change (EAPC) analyses. Multivariable logistic regression models with adjustment for clustering at the hospital level were used. Results: Of 1,944 patients with mUCB receiving CCTs, 191 (9.8%) received IPC. From 2004 through 2015, IPC use increased from 0.7% to 25.0%, respectively (EAPC, +23.9%; P<.001). In analyses stratified according to regions, the highest increase in IPC use was recorded in the Northeast (EAPC, +44.0%), followed by the West (EAPC, +26.8%), South (EAPC, +22.9%), and Midwest (EAPC, +15.5%). Moreover, the lowest rate of IPC adoption in 2015 was recorded in the Midwest (14.3%). In multivariable logistic regression models, teaching status (odds ratio [OR], 1.97; P<.001), more recent diagnosis (2010–2015; OR, 3.89; P<.001), and presence of liver metastases (OR, 1.77; P=.02) were associated with higher IPC rates. Conversely, Hispanic race (OR, 0.42; P=.03) and being hospitalized in the Northeast (OR, 0.36; P=.01) were associated with lower rate of IPC adoption. Finally, patients with a primary admission diagnosis that consisted of infection (OR, 2.05; P=.002), cardiovascular disorders (OR, 2.10; P=.03), or pulmonary disorders (OR, 2.81; P=.005) were more likely to receive IPC. Conclusions: The rate of IPC use in patients with mUCB receiving CCTs sharply increased between 2004 and 2015. The presence of liver metastases, infections, or cardiopulmonary disorders as admission diagnoses represented independent predictors of higher IPC use. Conversely, Hispanic race, nonteaching hospital status, and hospitalization in the Midwest were identified as independent predictors of lower IPC use and represent targets for efforts to improve IPC delivery in patients with mUCB receiving CCT.