1.5.5 Members of the specialist urology multidisciplinary team (including the bladder cancer specialist urological surgeon, stoma care nurse and clinical nurse specialist) should discuss with the person whether to have a urinary stoma or continent urinary diversion, and provide opportunities for the person to talk with people who have had these procedures.

Improving health and social care through evidence-based guidance Find NICE guidance. 1.7.1 Discuss the role of first‑line chemotherapy with people who have locally advanced or metastatic bladder cancer. Proportion of adults with newly diagnosed non-muscle-invasive bladder cancer who have a risk classification of their cancer completed. View options for downloading these results. 1.2.3

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1.4.5 Discharge to primary care people who have had low‑risk non‑muscle‑invasive bladder cancer and who have no recurrence of the bladder cancer within 12 months. However, the cost-effectiveness estimates assume that, despite a 2-year stopping rule, the effect of pembrolizumab continues for the duration of the model (a lifetime continued treatment effect) which is implausible.

NICE has produced resources to help implement its guidance on: NICE has written information for the public on each of the following topics. Therefore pembrolizumab can be recommended for use in the Cancer Drugs Fund. Assess and discuss the risks and benefits with the person.

There are many similar Summary of Product Characteristics from eMC.

predicted risk of recurrence and progression, estimated using a risk prediction tool. 1.5.6 Offer people with bladder cancer and, if they wish, their partners, families or carers, opportunities to have discussions with a stoma care nurse before and after radical cystectomy as needed. After radical cystectomy consider using a follow-up protocol that consists of: The recommendations only cover people with untreated PD-L1-positive locally advanced or metastatic urothelial carcinoma who cannot have cisplatin because more evidence became available after the committee meeting for people with disease that has progressed after platinum-containing chemotherapy. 1.3.9 For people in whom induction BCG has failed, the specialist urology multidisciplinary team should assess the suitability of radical cystectomy, or further intravesical therapy if radical cystectomy is unsuitable or declined by the person, or if the bladder cancer that recurs is intermediate‑ or low‑risk. NICE has published interventional procedures guidance on, fluorodeoxyglucose positron emission tomography, methotrexate, vinblastine, doxorubicin and cisplatin, transurethral resection of bladder tumour, Bites and stings – antimicrobial prescribing, Rehabilitation for adults with complex psychosis, Anaphylaxis: assessment and referral after emergency treatment, Anaemia management in people with chronic kidney disease, Hyperphosphataemia in chronic kidney disease, Sickle cell disease: acute painful episode, Genomic biomarker-based treatment for solid tumours, Metastatic malignant disease of unknown primary origin, Suspected cancer recognition and referral, Hyperglycaemia in acute coronary syndromes, Myocardial infarction with ST-segment elevation, Myocardial infarction: rehabilitation and preventing further cardiovascular disease, Cardiovascular disease: identifying and supporting people most at risk of dying early, Prophylaxis against infective endocarditis, Chronic fatigue syndrome 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or care home and inpatient mental health settings, Social care for older people with multiple long-term conditions, Urinary incontinence in neurological disease, Oral health improvement for local authorities and their partners, Community pharmacies: promoting health and wellbeing, Vitamin D: supplement use in specific population groups, Mental wellbeing and independence in older people, Social and emotional wellbeing for children and young people, Smokeless tobacco cessation: South Asian communities, Smoking: tobacco harm-reduction approaches, End of life care for people with life-limiting conditions, Looked-after babies, children and young people, Transition from children's to adults' services, Care and support of people growing older with learning disabilities, Excess winter deaths and illnesses associated with cold homes, Coexisting severe mental illness and substance misuse: community health and social care services, People’s experience in adult social care services, Service delivery, organisation and staffing, Emergency and acute medical care in over 16s: service delivery and organisation, Safe staffing for nursing in adult inpatient wards in acute hospitals, Managing medicines for people receiving social care in the community, Transition between inpatient hospital settings and community or care home settings for adults with social care needs, Opioids for pain relief in palliative care, Safe midwifery staffing for maternity settings, Controlled drugs: safe use and management, Managing long-term sickness absence and capability to work, Workplace health: policy and management practices, Bladder cancer – everything NICE says in an interactive flowchart, Managing non-muscle-invasive bladder cancer, Managing locally advanced or metastatic bladder cancer, Obtaining detrusor muscle during transurethral resection of bladder tumour, Chemotherapy during transurethral resection of bladder tumour, Discussing treatment options for high-risk non-muscle-invasive bladder cancer, Discussing treatment options for muscle-invasive urothelial bladder cancer, Accident prevention (see unintentional injuries among under-15s), Acute coronary syndromes (see chest pain), Acute hospitals (adult inpatient wards), safe staffing for nursing, ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction without ST-segment elevation (see chest pain), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-ST-segment elevation myocardial infarction (see chest pain), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), ST-elevation myocardial infarction (see myocardial infarction with ST elevation), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, recurrent non-muscle-invasive bladder cancer, intermediate-risk non-muscle-invasive bladder cancer, low-risk non-muscle-invasive bladder cancer, high-risk non-muscle-invasive bladder cancer, assess and reduce the environmental impact of implementing NICE recommendations, Improving supportive and palliative care for adults with cancer, Nivolumab for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy, Atezolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy, Pembrolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable, Pembrolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy, Atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable, Vinflunine for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract, Transurethral laser ablation for recurrent non-muscle-invasive bladder cancer, Reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia, Electrically stimulated intravesical chemotherapy for non-muscle-invasive bladder cancer, Intravesical microwave hyperthermia and chemotherapy for non-muscle-invasive bladder cancer, Intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy, National cancer patient experience survey, Atezolizumab for untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable, Supportive and palliative care services for adults with cancer, Healthcare services for urological cancers, Vinflunine for previously treated advanced or metastatic translational cell cancer of the urothelial tract, Collecting and re-using blood lost during radical surgery to remove the prostate gland or bladder, NICE's recommendations on the use of urinary biomarkers, atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable, pembrolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy, pembrolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable, atezolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy, nivolumab for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy, transurethral laser ablation for recurrent non-muscle-invasive bladder cancer, electrically stimulated intravesical chemotherapy for non-muscle-invasive bladder cancer, intravesical microwave hyperthermia and chemotherapy for non-muscle-invasive bladder cancer, solitary pTaG1 with a diameter of less than 3 cm, solitary pTaG2 (low grade) with a diameter of less than 3 cm.

. The guideline’s main aim is to help women choose which management option for urinary incontinence (UI) and pelvic organ prolapse (POP) is right for them, with a clear focus on the woman’s choice. Treatment for previously treated locally advanced or metastatic urothelial carcinoma is docetaxel or paclitaxel. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. The most plausible cost-effectiveness estimate is uncertain because it is not clear which overall survival extrapolation is most appropriate to use for the economic modelling. Discussing the benefits and risks of neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist helps adults to make an informed choice about the treatments that would best suit them. This guideline covers when to offer caesarean section, procedural aspects of the operation and care after caesarean section. NICE interactive flowchart - Bladder cancer, table of NHS England interim treatment regimens, COVID-19 rapid guideline: delivery of systemic anticancer treatments, information and support for people with bladder cancer, managing locally advanced or metastatic muscle-invasive bladder cancer, specialist palliative care for people with incurable bladder cancer, assess and reduce the environmental impact of implementing NICE recommendations, Adults with bladder cancer and their families and carers. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information. More about Neurogenic Bladder. Satisfaction with support received from a clinical nurse specialist, reported by adults with bladder cancer. Adults with suspected bladder cancer are offered a single dose of intravesical mitomycin C, given at the same time as the first transurethral resection of bladder tumour (TURBT).

NICE guideline [NG2] Offer people with bladder cancer and, if they wish, their partners, families or carers, opportunities to have discussions with a stoma care nurse before and after radical cystectomy as needed. 1.7.15 Consider hypofractionated radiotherapy or embolisation for people with intractable bleeding caused by incurable bladder cancer. A table of NHS England interim treatment regimens gives possible alternative treatment options for use during the COVID-19 pandemic to reduce infection risk. Relevance Because neither data collection from clinical practice or the ongoing trials would resolve the identified uncertainty, nivolumab is not suitable for use within the Cancer Drugs Fund for people with unresectable or metastatic urothelial cancer after platinum-containing therapy. Individuals with a Spinal Cord Injury (SCI) invariably have neurogenic bowel dysfunction which needs to be managed with an established and individualised bowel management programme. uterovaginal prolapse. Offer people who have chosen radical cystectomy a urinary stoma, or a continent urinary diversion (bladder substitution or a catheterisable reservoir) if there are no strong contraindications to continent urinary diversion such as cognitive impairment, impaired renal function or significant bowel disease. Informed consent should be obtained and documented.

Review clinical and cost effectiveness of new treatments. other people with bladder cancer who have had similar treatments. Do not take random biopsies of normal-looking urothelium during TURBT unless there is a specific clinical indication (for example, investigation of positive cytology not otherwise explained). 1.3.7 Offer induction and maintenance intravesical BCG to people having treatment with intravesical BCG. Neurogenic Bladder is caused by neurological damage. Denominator – the number of first TURBTs performed for adults with suspected bladder cancer.

Nivolumab meets NICE's criteria to be considered a life-extending treatment at the end-of-life. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. 1.2.10 Consider CT urography, carried out with other planned CT imaging if possible, to detect upper tract involvement in people with new or recurrent high‑risk non‑muscle‑invasive or muscle‑invasive bladder cancer. This guideline covers diagnosing and managing bladder cancer in people 18 and above referred from primary care with suspected bladder cancer, and those with newly diagnosed or recurrent bladder (urothelial carcinoma, adenocarcinoma, squamous-cell carcinoma or … Evidence of local arrangements and written clinical protocols to ensure that adults with muscle-invasive urothelial bladder cancer discuss neoadjuvant chemotherapy, radical cystectomy and radiotherapy using a radiosensitiser with a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist. This information is about the care and treatment of women who plan or need to have a caesarean section that. 1.2.11 Consider CT of the thorax, carried out with other planned CT imaging if possible, to detect thoracic malignancy in people with muscle‑invasive bladder cancer. Onset and evolution of clinical features (such as dysuria, nocturia and changes in urine appearance or odour).In older women or those with cognitive impairment... Evidence-based recommendations on fetal vesico–amniotic shunt for treating lower urinary tract outflow blockage in unborn babies, Evidence-based recommendations on prosthetic intervertebral disc replacement in the lumbar spine (replacing worn discs in the lower spine with artificial discs), Published by Accelerating Change Transformation Team (ACTT), 13 June 2017. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. 1.5.8 Use a radiosensitiser (such as mitomycin in combination with fluorouracil [5‑FU][1] or carbogen in combination with nicotinamide[2]) when giving radical radiotherapy (for example, 64 Gy in 32 fractions over 6.5 weeks or 55 Gy in 20 fractions over 4 weeks) for muscle‑invasive urothelial bladder cancer. solitary pTaG1 with a diameter of more than 3 cm, solitary pTaG2 (low grade) with a diameter of more than 3 cm. Also, find out when to see your GP and how bladder stones are treated. The guideline is an update of the 2013 NICE guideline on urinary incontinence in women and includes a new section on pelvic organ prolapse.

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