Raghav Varma

Objectives: To assess to what extent hospitals meet the uniform English National Health Service ‘timely’ treatment standard, what happens after a breach, and determinants of delay for patients with high‐risk renal cell carcinoma (RCC). Patient and Methods: Population‐based study using linked data for 7030 patients with high‐risk and 10 708 patients with low‐risk RCC, 2019–2023. The probabilities of ‘timely’ treatment and prolonged delay (≤31 days or >62 days from decision‐to‐treat, respectively) were estimated using multilevel logistic regression. Daily treatment probabilities beyond 31 days were represented using smoothed hazard rates. Results: For a typical patient with high‐risk RCC, timely treatment declined from 83.7% (2019) to 64.8% (2023), with a corresponding decline in the low‐risk group from 71.3% to 47.6%, while prolonged delays more than doubled, from 3.9% to 9.4%. Patients with high‐risk RCC were prioritised over those with low‐risk disease (73.6% vs 58.2%; adjusted risk ratio 1.26, 95% confidence interval 1.22–1.31). Older and more socioeconomically deprived patients experienced longer delays. Once the standard was breached, the daily probability of surgery declined sharply. Adjusted percentages of patients with high‐ and low‐risk RCC treated within the standard were strongly correlated ( r = 0.78). Conclusion: Prioritisation of patients with high‐risk RCC was maintained throughout the study period but did not prevent a system‐wide decline in timely treatment. Patients who breach the timely treatment standard face diminishing daily probabilities of surgery. Risk‐stratified standards, ring‐fenced surgical capacity, and monitoring beyond defined timely treatment standards are needed to safeguard patients against delays that have significant prognostic implications.

Introduction: Our experience with the presence of detrusor muscle (DM) following Trans-Urethral Resection of Bladder Tumour (TURBT). Objectives: To evaluate the presence of DM in primary TURBT specimens as a quality improvement exercise in Frimley Park Hospital, UK. And to assess if the level of the surgeon has impact on outcomes. Methods: Retrospective and prospective analysis of the electronic records from a single urology centre, servicing a group of urologists. Data collected over three consecutive audit loops between January 2014 and May 2018. Results: A total of 301 cases were performed under the care of seven consultant urologists. Analysis revealed a significant improvement in the overall quality of resections from 39% to 66% (50–84% for intermediate and high grade) after the introduction of the following interventions: (1) analysis and improved awareness of current practice; (2) introduction of European Association of Urology (EAU) guidelines by separating samples and sending a second specimen pot marked as bladder tumour base to look for DM; (3) dedicated urologists with an interest in bladder cancer performing en-bloc resection technique in appropriate cases. Conclusion: Through our closed-loop audits, we have demonstrated a considerable improvement in the quality of resections, resulting in accurate staging from the initial resection. This could in turn lead to improved over all prognoses and negating the need for re-resection in all cases of high-risk non-muscle invasive bladder cancer (NMIBC). Level of evidence: 3