University of Oulu

Sell, V., Ettala, O., Montoya Perez, I. et al. Symptoms and diagnostic delays in bladder cancer with high risk of recurrence: results from a prospective FinnBladder 9 trial. World J Urol 38, 1001–1007 (2020).

Symptoms and diagnostic delays in bladder cancer with high risk of recurrence : results from a prospective FinnBladder 9 trial

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Author: Sell, Ville1; Ettala, Otto1; Perez, Ileana Montoya2;
Organizations: 1Department of Urology, Turku University Hospital, Turku, Finland
2Department of Future Technology, University of Turku, Turku, Finland
3Department of Urology, Helsinki University Hospital, Helsinki, Finland
4Department of Urology, Tampere University Hospital, Tampere, Finland
5Department of Urology, Oulu University Hospital, Oulu, Finland
6Department of Surgery, Satakunta Central Hospital, Pori, Finland
7Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
8Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
9Department of Urology, Kuopio University Hospital, Kuopio, Finland
10Department of Surgery, Hospital of Hyvinkää, Hyvinkää, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-06-25


Purpose: To investigate the symptoms and delays in the clinical pathway of bladder cancer (BC).

Methods: This is a substudy of a prospective, randomized, multicenter phase III study (FinnBladder 9, NCT01675219) where the efficacy of photodynamic diagnosis and 6 weekly optimized mitomycin C instillations are studied in pTa bladder cancer with high risk for recurrence. The data of presenting symptoms and critical time points were prospectively collected, and the effect of factors on delays was analyzed.

Results: At the time of analysis, 245 patients were randomized. Analysis included 131 patients with primary bladder cancer and their complete data. Sixty-nine percent had smoking history and 67% presented with macroscopic hematuria. Median patient delay (from symptoms to health-care contact) was 7 days. The median general practice delay (from health-care contact to urology referral) was 8 days. Median time from urology referral to cystoscopy was 23 days and from cystoscopy to TUR-BT 21 days. Total time used in the clinical pathway (from symptom to TUR-BT) was 78 days. Current and former smokers had non-significantly shorter patient-related and general practice delays compared to never smokers. TUR-BT delay was significantly shorter in patients with malignant cytology (16 days) compared to patients with benign cytology (21 days, p = 0.03).

Conclusions: Patient-derived delay was short and most of the delay occurred in the referral centers. The majority had macroscopic hematuria as the initial symptom. Surprisingly, current and past smokers were more prone to contact the health-care system compared to never smokers.

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Series: World journal of urology
ISSN: 0724-4983
ISSN-E: 1433-8726
ISSN-L: 0724-4983
Volume: 38
Issue: 4; SI
Pages: 1001 - 1007
DOI: 10.1007/s00345-019-02841-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3122 Cancers
Funding: Open access funding provided by University of Turku (UTU) including Turku University Central Hospital.
Copyright information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.