Turbt – Can we do it better? Yes, we can

Reljić A¹, Tomić M¹, Tomašković I¹, Ulamec M², Krušlin B², Trnski D¹

Dpt. of urology¹ and Dpt. for clinical pathology²,
University Hospital Center „Sestre milosrdnice“, Zagreb, Croatia


PURPOSE – 43% of invasive bladder cancers (T≥2) arose by means of progression from non-muscle invasive carcinomas (NMIBC) and their prognosis is worse in comparison with primary T≥2 cancers. Since prognosis depends on the quality of  initial resection we evaluate the features of TURBT for NMIBC at our institution.

METHODS – 356 TURBT (259 primary and 97 second-look procedures) was undertaken in 12-months period. The stage, grade, size and focality of the tumors, surgeons age and frequency of video equipment use were evaluated. The presence of the muscularis propria in the specimens was used as quality-marker for surgical skills but hystological expertise also.

RESULTS – Muscularis propria were present in 75,6% of specimens (71,3% in primary vs. 87,9% of  second-look procedures, p=0,001). In 32/356 (8,98%) hystological findings the presence (nor absence) of muscularis propria was not reported. 35 out of 97 second-look TUR were tumor-positive and 5/35 (14,2%) discovered T≥2 cancer.The stage (Ta vs. T1, p=0,173), size (<3≤cm, p=0,394) nor focality (solitary vs. multifocal, p=0,484) were predictive for residual cancer. Grade 3 of the initial tumor was strong predictor for residual disease (G3 vs. G<3, p=0,005).We have not done second-look TUR in165 patients and 36 of them (21,8%) had the G3 cancer. Although younger collagues performed both primary and second-look resection considerably fewer than older urologists, muscularis propria was present in equal proportion in two groups of surgeons (79,4% vs.78,0%, p=0,769). Video TURBT was performed in minority of procedures (23,7%) mainly by younger surgeons.

CONCLUSIONS – We can be satisfied with overall TURBT performance. Closer cooperation with pathologist, more consistency in indications for second-look TUR, more younger surgeons with video equipment and supervision by experienced urologists are just a few recommendations for further improvements