Arturo Mendoza-Valdés: Well, thank you very much, Ashish. Nice to see you now by Zoom after having a fantastic meeting last October 3 or 4 in Mexico City. Thank you for the invitation to the Mexican urologists to make up the Mexican Bladder Cancer Guidelines, which were organized by myself, the president, and past president of the Mexican Urologic Oncology Association. Having said this, the organizations that participated in this great invitation by Ashish were the Mexican Urologic Oncology Association, the Mexican Urologic Association, and another two urological associations that we have in Mexico, as well as the Board of Urology. We started all these with some questions that were answered by Ashish and myself to begin this. One of these questions was why do we need the Mexican Bladder Cancer Guidelines? And the answer is very easy. We all know that there are many guidelines, but there are a few differences. It was good for Mexico to have the best of all of them, especially those given by the International Bladder Cancer Group, and to adapt them to the conditions of our country. Since we have many associations, it was even more important to do this. Who participated in this?
Well, mainly people from the International Bladder Cancer Group by Ashish Kamat, Roger Buckley, Roger Li, Mario Fernandez, Andrea Apolo. And from Mexico, well, here are the societies that I mentioned, and these are the names of those people from each of the associations. Another interesting thing was that there were about 40 urologists from all the healthcare institutions of our country, mainly from all the government institutions, IMSS, ISSSTE, and... Well, it's not important to mention them, but the important thing is that we were lucky and we were very satisfied in the fact that all the institutions from the government and private hospitals participated in this, so it was really a good representation of the urologists involved, interested, and expert in bladder cancer of our country. Here, you see the picture of all the participants. Here, you can see Roger Buckley, and here's myself. Somewhere in these pictures here is Ashish. The methodology that we use is the one that is usually used in the International Bladder Cancer Group meetings, which is a modified Delphi consensus.
You all know about these. We discuss, it's voted, and then discussed again until everybody gets to an agreement. The topics that we divided these discussions were screening and diagnosis that was given by Roger Buckley. One of the main topics that we talked about was the updated approach of hematuria, which is one of the first symptoms of patients with bladder cancer. We used the risk of having cancer in people with hematuria. He also stated, for example, the importance of smoking cessation and the usefulness or not of tumor markers. We don't have in Mexico all the tumor markers you have for bladder cancer, so we discuss this, we discuss the importance of cytology and the unification of criteria. Then we talked about non-muscle-invasive bladder cancer given by Roger Li. He talked about, for example, the impetus of different light sources we don't have access to in Mexico, to the newest like blue light. But in the guidelines, we mentioned that it is important to use them when and where available.
He also mentioned the importance of using the urine by barbotage and not only spontaneous voiding of urine. Then we followed with muscle-invasive bladder cancer, which was given by Mario Fernandez from Chile. Let me imagine here that in Chile in 2023, they also had the Chilean Bladder Cancer Guidelines. It was very helpful to talk with him who had a previous experience in his country. Besides being an important support for us for organizing the Mexican Guidelines, he talked about the muscle-invasive bladder cancer, he talked about the indication for radical cystectomy, the importance of preparing the patient for this, and the very specific situations for partial cystectomy is indicated. Then we follow about the metastatic urothelial cancer. This lecture was given by Andrea Apolo. Of course, she talked about the first line, the second line, beyond the second line, and all the available new drugs for immunotherapy and everything. We discussed what is available in Mexico. Not all the drugs are available. Some of them soon to be. But we discussed what is available and what is not in Mexico.
In all these chapters, we talked about what is going on in the world, what is accepted in the IBCG, and what we have in Mexico or not. Everybody who participated discussed most of the more important topics. There was a big discussion, there was a voting, and at the end, the second day, we made up a final discussion and approval of the main topics. What are the expectations and future of what we did? Well, first of all, to complete what we have done, updated it, published probably in the first semester of next year. All this that we have been doing was presented two weeks ago in the Mexican Urological Association meeting in Guadalajara. It will be presented in another meeting in January, in June, and in July in the Mexican Urological Oncology Association where she has participated many times in July in '26 in Acapulco, and then in the Mexican Urological Association next year again where hopefully we have all these complete. We will present and make a division of the Mexican Bladder Cancer Group in every possible meeting, including some of general practitioners, internal medicine, obviously not in detail, but the importance of early detection and the smoking cessation.
I think that the most important conclusion of this fantastic meeting is that we're very lucky to get together all the urologic associations that we have in Mexico, all the government institutions, and the main urology team in all these hospitals, including the military hospital, and that was a big success. This is something that has never happened in Mexico in any topic. This, itself, was a big success. The good thing about getting all these people, all these associations together was to get the Mexican Bladder Cancer Guidelines. I think the success was double. One, developing the Mexican Bladder Cancer Guidelines, and second, get all the main urologists together in one meeting, which has never happened. All the Mexican Urological Associations and all the institutions represented in this. That is something that I have personally to thank Ashish Kamat because it was because of his invitation at his initiative. What we are looking for in the future, getting other associations related to this, like the Medical Oncology Association, the Radiotherapy Association, and Nuclear Medicine. I think this is the summary of what we did, and this is something that, I repeat, I want to thank Ashish Kamat for it.
Ashish Kamat: Thank you, Arturo, very much for that very nice presentation and for the kind words. I do have to say that kudos to you because even though I helped you with it, this was essentially all your doing. You had to get everybody together, and that's something that you're very good at doing. You get people together. It was amazing to see all the representatives in one room. Clearly, this is an unmet need that was fulfilled, and that's why there was a lot of enthusiasm. One thing that you said repeatedly during the guidelines discussion and I think is very important is just because you don't have something in Mexico doesn't mean we should lower the standards. We should set the standards and then try to get those resources. Could you share with us a little bit your thoughts behind how that might be feasible?
Arturo Mendoza-Valdés: Well, yes. Some of the limitations are because of the government, that it takes bureaucracy. That's one thing. But sooner or later, we have always got, if not all, most of the drugs. The second limitation is economic. The government and the people, there are many, especially the newest available in immunotherapies, extremely expensive. That's the second limitation. The third limitation is that communication, but that's not only specific for Mexico. I've been reading that even in the States and in all countries, the number one limitation is that even urologists are not acquainted with the guidelines. If they are acquainted, they just don't follow them up. But that's not specific for Mexico. That's all over the world. But one way to start doing this is sharing, promoting the guidelines. I would say those are the limitations, but nothing stays forever. Nothing lasts forever. Not the bad, not the good. I am sure that working hard, we will overcome all those limitations.
Ashish Kamat: You've shown that multiple times, Arturo, with everything you've done over the years. I mean, you are a mentor to your trainees, your residents, your fellows. You, of course, travel around the world teaching about urology and bladder cancer. Share with us a little bit about your vision for where these guidelines are going to go in the next six months to one year. Where do you think these are headed? How do you think you can get this disseminated? Obviously, through channels such as what you mentioned, UroToday as well, but what else do you think you could do to help spread the word?
Arturo Mendoza-Valdés: Well, I think that, as I said, we will take advantage of every single urologic and even non-urologic meetings to share this effort. If we started working together for these guidelines, then that means that we can get together all these urologists and all these institutions not only for sharing or promoting the guide, but even to start doing together research. For example, maybe they make... I don't know. Just getting together the data, the experience of every single place. One thing that I have to mention is that, fortunately in Mexico, we don't have scarcity or problems with BCG. That's an advantage that we have in Mexico, different to other countries, including the States. We have availability enough of BCG. There's no lack of it. As you asked, what do I see in the future? What I see in the future is that we will improve the care of patients with bladder cancer, mainly because there's an agreement. It will not happen that everybody does what they care, but we will be a little bit more unified criteria for all the stages.
Ashish Kamat: Very well said, Arturo. I want to congratulate you once again. This was a milestone achievement, and it could not have been possible without your leadership. So, congratulations and thank you for taking the time.
Arturo Mendoza-Valdés: Thank you very much for the support, and thank you again for the invitation. This is just a beginning. We haven't finished yet. We are only beginning. This is a very good start, I think. Thank you very much.