Department of Urology and Andrology, Donauspital, Vienna, Austria.
BJU Int. 2013 Jul;112(1):68-73. doi: 10.1111/j.1464-410X.2012.11661.x. Epub 2013 Jan 15.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Urothelial carcinoma of the bladder (UCB) is more prevalent in men than women; however, in women the tumour stage is generally more advanced at the time of the diagnosis and the prognosis is worse. Possible explanations include anatomical, genetic and socio-economic factors. The study shows that clinical symptoms before the first-time diagnosis of UCB did not differ between the sexes, while primary care and referral patterns did. Women were more likely to receive symptomatic treatment or therapies for alleged UTIs without further investigation or referral to urological evaluation. The study highlights the fact that there may be a diagnostic delay in women which could contribute to the gender-dependent disparities in stage distribution and prognosis of UCB.
To evaluate gender-dependent disparities regarding clinical symptoms, referral patterns or treatments before diagnosis of urothelial carcinoma of the bladder (UCB).
A consecutive series of patients with newly diagnosed UCB completed a questionnaire at the time of admission for elective transurethral resection of a bladder tumour (TURBT). The questionnaire surveyed the presence of haematuria, dysuria, urgency and bladder pain as well as the number of consultations and treatments before urological evaluation. Tumour characteristics, clinical symptoms, treatments and referrals were compared between men and women in the patient series.
In men (n = 130) the distribution of tumour stages was pTa 62.3%, pT1 23.1% and pT ≥ 2 12.3%. The respective percentages in women (n = 38) were pTa 57.9%, pT1 23.7% and pT ≥ 2 18.4% (P > 0.05). The prevalence of clinical symptoms in men vs women was as follows: gross haematuria 65 vs 68%, dysuria 32 vs 44%, urgency 61 vs 47%, and nocturia 57 vs 66%, respectively (P > 0.05). A total of 78% of men vs 55% of women directly consulted a urologist (P < 0.05). Symptomatic treatment for voiding disorders/pain was given without further evaluation to 19% of men vs 47% of women 1 year before the diagnosis of UCB (P < 0.05). A total of 3.8% of men vs 15.8% of women received three or more treatments for urinary tract infections (UTIs) within the same time period (P < 0.05).
In the present study there were no gender-related differences in clinical symptoms of UCB, but women were more likely to be treated for voiding complaints or alleged UTIs without further evaluation or referral to urology than men. Gender-dependent disparities in referral patterns exist and might delay definitive diagnosis of UCB in women.
膀胱癌在男性中的发病率高于女性；然而，女性在诊断时肿瘤分期通常更为晚期，预后更差。可能的解释包括解剖学、遗传学和社会经济学因素。
评估膀胱癌（UCB）诊断前的临床症状、就诊模式或治疗的性别差异。
连续系列新诊断为 UCB 的患者在接受经尿道膀胱肿瘤切除术（TURBT）的择期治疗时填写一份问卷。该问卷调查了血尿、排尿困难、尿急和膀胱疼痛的存在情况以及在接受泌尿科评估之前的就诊次数和治疗次数。在患者系列中比较了男性和女性的肿瘤特征、临床症状、治疗和转诊情况。
在男性（n=130）中，肿瘤分期分布为 pTa 62.3%、pT1 23.1%和 pT≥2 12.3%。女性（n=38）的相应百分比分别为 pTa 57.9%、pT1 23.7%和 pT≥2 18.4%（P>0.05）。男性与女性的临床症状发生率如下：肉眼血尿 65% vs 68%、排尿困难 32% vs 44%、尿急 61% vs 47%、夜尿症 57% vs 66%（P>0.05）。直接咨询泌尿科医生的男性占 78%，女性占 55%（P<0.05）。在膀胱癌诊断前 1 年，有 19%的男性接受了针对排尿障碍/疼痛的对症治疗，而女性则有 47%接受了同样的治疗（P<0.05）。在同一时期内，男性中有 3.8%接受了三次或更多次治疗尿路感染（UTI），而女性中有 15.8%接受了同样的治疗（P<0.05）。
在本研究中，膀胱癌的临床症状无性别差异，但女性比男性更有可能因排尿不适或疑似 UTI 而接受治疗，而无需进一步评估或转诊至泌尿科。就诊模式存在性别差异，可能会导致女性膀胱癌的确诊延迟。
