Evaluating the Compatibility of Treatment Protocol for Intravesical Non-muscle Invasive Bladder Cancer with the National Clinical Guideline at Urmia Imam Khomeini Hospital

Abstract

Background: Non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease characterized by a high risk of recurrence and progression. Clinicians have various surgical and therapeutic options available for managing NMIBC. Objectives: This evaluated the alignment of treatment practices at all hospitals in Urmia, a south-west province of Iran, with current guidelines for treating NMIBC. Methods: This cross-sectional study included 134 patients with NMIBC. Demographic data, medical history, perioperative intravesical therapy, imaging results, cytology findings, and surgical procedures were collected. Intravesical chemotherapy with mitomycin C, and post-surgical immunotherapy with Bacillus calmette-guérin (BCG) including induction and maintenance regimens and durations, were also recorded. Treatment protocols were compared to established guidelines using IBM SPSS statistics version 21. Results: The mean age of patients was 65 years, with 79.17% being male. Adherence to clinical guidelines was 45.5% for obtaining a separate sample from the tumor base, 40.3% for urinary cytology, 67.9% for performing re-transurethral resection of bladder tumors (TURBT), and 68.4% for performing re-TURBT within the appropriate timeframe. Among the patients indicated for re-TURBT, only 30% underwent the procedure. Mitomycin treatment was not used in 94.4% of low-risk patients. Induction treatment with BCG was compatible with guidelines in 86.6% of patients. Compliance with maintenance treatment was 69.8%, and adherence to the recommended duration was 55.2%. Only 55% of patients with indications received maintenance treatment. Overall treatment compliance with clinical guidelines was good in 19.4%, intermediate in 32.8%, and poor in 47.8%. Conclusions: Overall adherence to clinical guidelines for the management of NMIBC was found to be suboptimal, particularly among low-risk patients.