Introduction and objectives: This study prospectively evaluated the relationship between pre-procedural pain expectations and experienced pain during first-time office-based cystoscopy, and assessed whether the discrepancy between them is influenced by age and gender in an outpatient tertiary care setting. Materials and methods: This prospective study included adults undergoing first-time office-based cystoscopy between January and April 2026, excluding those with prior cystoscopy or chronic pain requiring analgesics/anxiolytics. All procedures were performed by a single urologist using a 16-Fr flexible cystoscope with intraurethral lidocaine. Expected and experienced pain were assessed using a 0-10 numerical rating scale and analyzed by age and gender, with p < 0.05 considered significant. Results: A total of 117 patients (83 males, 34 females; mean age 57.6 +/- 11.7 years) were included. Post-procedural pain scores were significantly lower than pre-procedural expectations in both male and female patients (all p < 0.001). The magnitude of pain reduction did not differ significantly between male and female patients (p = 0.114) or between patients aged < 65 and >= 65 years (p = 0.573). Overall, median pain scores de creased from 6 (5-7) before the procedure to 2 (2-4) after the procedure. Procedure duration was 1.54 +/- 0.3 min and did not differ by sex or age. The majority of patients (81.2%) would undergo repeat cystoscopy if required, with no significant difference between male and female patients. Conclusions: Patients undergoing office-based cystoscopy report significantly lower pain than anticipated, and these findings may inform clinical counseling by facilitating reassurance and contributing to reduced anxiety through effective pre-procedural education.
Objective: Non-muscle-invasive bladder cancer (NMIBC) has a high risk of recurrence and requires intensive long-term surveillance. Existing clinical risk models offer limited prognostic accuracy. Molecular urine-based assays may improve prognostic assessment accuracy of future recurrence. This study evaluated whether Digital Uromonitor (R) (dUM), detecting TERT and FGFR3 mutations via ddPCR, enhances prognostic assessment of twoyear recurrence beyond cystoscopy and cytology in a prospective multicenter cohort. Methods: This prospective, multicenter observational study (EVALUATION-CUETO; NCT05864599) enrolled consecutive NMIBC patients from 26 institutions. Eligible participants had an index tumor diagnosed 3 months-2 years before recruitment and completed two years of follow-up with sufficient DNA for dUM analysis. Clinical, pathological, and biomarker variables (cystoscopy, cytology, dUM) were collected. Recurrence rate was defined as events per year and classified as high (R > 0.5) or low (R 5 0.5). Results: Of 201 included patients, 75 (37%) were dUM-positive; TERT promoter mutations accounted for 88% of these cases. dUM showed prognostic value, correctly identifying 59% of recurrences over two years of stan dardized FU, outperforming cystoscopy alone (42%), with specificity of 74% and NPV of 78%. Combining dUM with cystoscopy increased sensitivity to 71%. Patients negative for both cystoscopy and TERT had the lowest recurrence risk (14%), whereas dual-positive patients exceeded 80%. High baseline recurrence rate consistently increased risk across all biomarker categories. Conclusions: dUM provides robust, reproducible prognostic information and significantly improves molecular risk stratification in NMIBC. These findings support its potential integration into risk-adapted surveillance strategies, pending validation in larger populations.
Overactive bladder management within the Spanish healthcare system faces significant challenges, including suboptimal therapeutic adherence. This consensus proposes recommendations to improve the care process (both clinical and organizational) from an adherence perspective. A Multidisciplinary Working Group of 14 members critically reviewed and discussed the literature (individually and in joint sessions) and formulated recommendations around five pillars: (1) strategic planning, with a realistic medium-term horizon and progress toward common protocols; (2) technological innovation and digitalization, enabling bidirectional communication among professionals, follow-up, clinical decision-making, and interoperability; (3) coordination and collaboration, across levels of care, healthcare professionals, and patients; (4) a focus on health outcomes and quality of life, with personalized treatments and continuous monitoring; and (5) social awareness and patient empowerment, increasing disease visibility, raising awareness among the public and patients, and fostering active patient participation.
El abordaje de la vejiga hiperactiva (VH) en el sistema sanitario español afronta retos relevantes, entre ellos una adherencia terapéutica deficiente. Este consenso propone recomendaciones de mejora del proceso asistencial (clínico y de gestión) desde la óptica de la adherencia. Un Grupo de Trabajo Multidisciplinar (GTM) de 14 integrantes revisó y discutió críticamente la literatura existente (de forma individual y en sesiones conjuntas) y formuló recomendaciones en torno a cinco ejes: (1) planificación estratégica: con visión realista de medio plazo y avanzando hacia protocolos comunes; (2) innovación tecnológica y digitalización: que faciliten comunicación bidireccional entre profesionales, seguimiento, toma de decisiones clínicas e interoperabilidad; (3) coordinación y colaboración: entre niveles asistenciales, profesionales y pacientes; (4) orientación a resultados en salud y calidad de vida: con tratamientos personalizados y monitorización continua; (5) conciencia social y empoderamiento de pacientes: aumentando la visibilidad de la patología, sensibilizando a ciudadanía y pacientes, y fomentando su participación activa.
