Consensus Definition and Prediction of Complexity in Transurethral Resection or Bladder Endoscopic Dissection of Bladder Tumours

Abstract

Ten senior urologists were interrogated to develop a predictive model based on factors from which they could anticipate complex transurethral resection of bladder tumours (TURBT). Complexity was defined by consensus. Panel members then used a five-point Likert scale to grade those factors that, in their opinion, drove complexity. Consensual factors were highlighted through two Delphi rounds. Respective contributions to complexity were quantitated by the median values of their scores. Multivariate analysis with complexity as a dependent variable tested their independence in clinical scenarios obtained by random allocation of the factors. The consensus definition of complexity was “any TURBT/En-bloc dissection that results in incomplete resection and/or prolonged surgery (>1 hour) and/or significant (Clavien-Dindo ≥ 3) perioperative complications”. Logistic regression highlighted five domains as independent predictors: patient’s history, tumour number, location, and size and access to the bladder. Receiver operating characteristic (ROC) analysis confirmed good discrimination (AUC = 0.92). The sum of the scores of the five domains adjusted to their regression coefficients or Bladder Complexity Score yielded comparable performance (AUC = 0.91, C-statistics, p = 0.94) and good calibration. As a whole, preoperative factors identified by expert judgement were organized to quantitate the risk of a complex TURBT, a crucial requisite to personalise patient information, adapt human and technical resources to individual situations and address TURBT variability in clinical trials.

National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients

“…To account for TURBT case variation, we used strict inclusion criteria for TURBT cases and used mean performance scores for two cases before training and two cases after training. However, differences in case complexity could still influence the scores, and future studies should consider including assessment of each case, for example, by using the novel Bladder Complexity Checklist developed by a Delphi panel of international specialists and stakeholders in TURBT and bladder cancer treatment [4] . However, the strong correlations for the two pretraining procedures and the two post-training procedures indicate that the variation in complexity did not affect the effect sizes.…”

“…Complete tumour eradication and adequate tissue sampling for histopathological diagnosis are paramount for accurate risk stratification in BC [3] . Although the anatomy and technical armamentarium seem simple, TURBT is a highly complex procedure [4] .…”

Predicting Complexity in Transurethral Resection of Bladder Tumours: External Validation and Modification of the Bladder Complexity Score

“…A total of 43 preoperative clinical factors in 5 subgroups that relate to a complex TURBT were identified by several expert Delphi rounds and organised into a Bladder Complexity Checklist (BCC). The BCS was subsequently validated using approximately 130 fictitious clinical scenarios [9]. So far, no external validation on real clinical data has been performed.…”

Insights into Urological Cancer

“…Two articles [ 22 , 23 ] and two reviews [ 24 , 25 ] dealing with urothelial tumors have been included in this collection of urological neoplasia. Chien et al [ 22 ] described in a study of 635 patients, how the overexpression of the microtubule-associated protein 1b ( MAP1B ) is an independent prognostic factor with adverse clinical outcomes and shorter survival in both upper urinary tract and bladder urothelial carcinomas.…”

“…The two reviews come directly from the clinical perspective. A multi-institutional and international group of urologists achieved a consensus to define and predict the complexity of transurethral resection and dissection of bladder tumors, a crucial issue to optimize and adapt human and technical resources to every clinical setting [ 24 ]. Most urothelial carcinomas are composed of clearly recognizable, though more or less differentiated, transitional cells.…”