How well do we manage non-muscle invasive bladder tumors? A UK audit of real-life practices

Abstract

Objective: The aim of this study was to assess the quality of TURBT (transurethral resection of bladder tumor) using surrogate parameters and evaluate adherence to the guidelines regarding the management of bladder tumors. Materials and methods: A clinical audit of all new diagnosis of bladder cancer was undertaken from January 2016 to January 2017. A total of 101 new bladder cancer cases were included. Surrogates of TURBT quality including presence of detrusor in the specimen, rate of re-TUR, presence of carcinoma in situ, and 3-month recurrence rates were analyzed. Adherence to guidelines regarding management of non-muscle invasive bladder cancer including time to re-TUR and utilization of single instillation chemotherapy was evaluated. Results: Absence of detrusor muscle in the specimen of the initial TURBT was noted in 22.8% of the cases. The chance of including muscle in the specimen was almost four-fold for tumors larger than 3 cm. A single instillation of intravesical chemotherapy following TURBT was administered in only 40% of eligible patients; 54.3% of patients had a re-TUR, the majority (61.3%) for high-grade non-muscle invasive bladder cancer on initial TURBT. Re-TUR was done on average 10 weeks after initial TURBT. The 3-month recurrence rate was 36.0% with larger tumors (>3 cm) being more prone to early recurrences. Early recurrences were not affected by intravesical instillations with bacillus Calmette–Guérin or mitomycin C although there was a positive association between the presence of carcinoma in situ on initial resection and early recurrences. Discussion and conclusion: One in two patients will have a re-TUR, and approximately one in two patients will have tumor on re-TUR. Single immediate chemotherapy instillations after TURBT are underutilized. The presence of carcinoma in situ on initial TURBT and tumor size were predictors of early recurrences.

Concomitant Endoscopic Surgery for Bladder Tumors and Prostatic Obstruction: Are We Safely Hitting Two Birds with One Stone? A Systematic Review and Meta-Analysis

“…Single intravesical instillation of chemotherapy is recommended for most patients undergoing TURBT as it reduces tumor recurrences by destroying circulating tumor cells and displaying an ablative effect on residual tumor cells [ 40 ]. However, in line with the low adherence to single-instillation chemotherapy [ 41 ], postoperative instillation across included studies was performed only in studies where prostate surgery was performed by laser and not by electrosurgery [ 28 , 34 ]. Single-instillation postoperative chemotherapy following TURP was avoided due to the increased risk of bleeding and extravasation of the chemotherapeutic agent.…”

En bloc resection, is this the future of non-muscle invasive bladder cancer management? Presentation of our technique and brief review of the literature

“…9 In roughly half of the cases, DM a surrogate marker for resection quality, is not present in the specimen translating into unsatisfactory oncological outcomes. 1,4 Moreover, the lack of DM affects disease prognosis, leading to suboptimal care for bladder cancer patients. 1,10 Interestingly, over the past few years, we are witnessing a paradigm shift in bladder treatment.…”

“…1,4 Moreover, the lack of DM affects disease prognosis, leading to suboptimal care for bladder cancer patients. 1,10 Interestingly, over the past few years, we are witnessing a paradigm shift in bladder treatment. ERBT attracted international attention offering demonstrable higher rates of DM, in some cases up to 95%, compared to traditional TURBT.…”

“…Bladder cancer is one of the most common urological malignancies. 1 Non-muscle invasive bladder cancer (NMIBC) disease accounts for roughly 75%-85% of newly diagnosed cases. 2,3 To date, conventional transurethral resection of bladder tumors (TURBT) remains the established cornerstone of therapy.…”

“…4,5 Although the standard of care for decades, TURBT is criticized for its high recurrence and under-staging rates. 1,6 The latter impinges En bloc resection, is this the future of non-muscle invasive bladder cancer management? Presentation of our technique and brief review of the literature on the rising lifetime surveillance and treatment costs of the disease.…”