Impact of a teaching program on outcome quality of white light transurethral resection for bladder tumor: A cohort study

Abstract

Objective: To test the hypothesis that a teaching program improves the quality of transurethral resection of bladder tumor (TURBT) and decreases the risk of early recurrence. Material and methods: This is an observational retrospective cohort study of prospectively recorded data of patients with first clinical diagnosis of non-muscle-invasive bladder cancer (NMIBC), scheduled for TURBT. In 2005 a systematic TURBT teaching program was introduced in our Department. We reviewed the charts of patients who underwent TURBT in the years 1998-2004, when no tutoring was applied, and those who underwent TURBT in the years 2005-2010. The outcomes of interest were: presence/absence of detrusor muscle (DM), carcinoma in situ (CIS) detection, complication rate and recurrence rate at the first follow-up cystoscopy (RRFF-C). Results: Complete data from 427 patients were available: 199 before and 228 after the introduction of the teaching program. Multivariable logistic analysis showed that the training program was an independent prognostic factor for DM (presence) rate (OR = 3.92, 95%CI = 2.42-6.33), CIS detection rate (OR = 4.36, 95%CI = 1.92-9.86), and complication rate (OR = 0.28, 95%CI = 0.15-0.55), but not for RRFF-C (OR = 0.79, 95%CI = 0.52-1.20). Between 1998-2004, RRFF-C was correlated with tumor number, pathological stage, DM presence, presence of complication, CIS detection and surgeon experience. After the introduction of the teaching program, only tumor number, DM presence and surgeon experience influenced the RRFF-C. Conclusion: Our findings suggest the hypothesis that the teaching program might have an impact of quality of TURBT, but it failed to improve the RRFF-C.

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

“…The effect of training and resultant surgical experience on the presence of detrusor muscle was evident in a study from tertiary center, in which multivariable logistic analysis showed that the establishment of a training program was an independent prognostic factor for the rate of presence of DM (OR = 3.92, 95% CI = 2.42-6.33). 9 However, the between-surgeon differences in the recurrence risk were not that pronounced for smaller tumors. Mariappan et al 10 showed that the presence of detrusor muscle in the first specimen and surgeon's experience were the two factors that were significantly associated with a lower recurrence rate.…”

“…The effect of training and resultant surgical experience on the presence of detrusor muscle was evident in a study from tertiary center, in which multivariable logistic analysis showed that the establishment of a training program was an independent prognostic factor for the rate of presence of DM (OR = 3.92, 95% CI = 2.42–6.33). 9…”

Head-to-Head Comparison between High-Resolution Microultrasound Imaging and Multiparametric MRI in Detecting and Local Staging of Bladder Cancer: The BUS-MISS Protocol

“…The surgical procedure was performed according 122 to the standard technique at our institution which are 123 in line with the EAU guidelines and take into account 124 the TURBT pre-operative checklist [16,17].…”