Epidemiology and clinicopathological characteristics of tumoral and non-tumoral bladder lesions in Bistrița-Năsăud county, Romania: A retrospective analysis (2018-2023) and the impact of the COVID-19 pandemic

Abstract Objective : The primary aim of this study was to analyze the temporal trend and the histopathological and demographic characteristics of tumoral and non-tumoral bladder lesions diagnosed at the Pathology Department of the Bistrița-Năsăud County Emergency Clinical Hospital, Romania between 2018 and 2023. A secondary objective was to assess the impact of the COVID-19 pandemic on tumor diagnosis. Methods : We conducted a retrospective observational study including 279 cases diagnosed via bladder biopsy, transurethral resection of bladder tumor, and cystectomy. Variables such as age, sex, environment, intervention type, histopathological diagnosis, and TNM staging were collected. Statistical analysis was performed using Epi Info and Microsoft Excel, with a significance threshold set at p<0.05. Results : Invasive urothelial tumors were the most common (n=144 cases, 51.61%), followed by non-invasive urothelial tumors (n=95, 34.05%), non-tumoral lesions (n=31, 11.11%), and non-urothelial tumors (n=9, 3.22%). Most cases occurred in men (n=226, 81%), particularly in the 61–70 and 71–80 age groups. Non-muscle invasive bladder cancers (pTa, T1) were triple as frequent as muscle-invasive bladder cancers. Comparing the pre-pandemic/pandemic (2018–2020) and post-pandemic (2021–2023) periods, we observed a 88% increase in total diagnosed cases (p<0.0001) along with a significant rise in both non-muscle invasive bladder cancers (+70%, p=0.002) and muscle invasive bladder cancers (+106%, p=0.017), the latter showing a more pronounced increase. Conclusions : Our study provides a comprehensive overview on the impact that COVID-19 pandemic has had on the diagnosis of bladder lesions within Bistrița County area. The post-pandemic group exhibited a marked rise in both tumoral and non-tumoral lesions, as well as in the number of MIBCs, highlighting the effect of pandemic related restriction on patients care. Nevertheless, our results need further confirmation through future larger scale studies.