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Keywords:

  • bladder cancer;
  • transurethral resection of bladder tumour;
  • quality

Objectives

  • To determine the quality of transurethral resection of bladder tumour (TURBT) in the UK.
  • To evaluate the utility of a novel ‘snapshot’ methodology in carrying out national audits.

Patients and Methods

  • Every consultant Urologist in the UK was asked to contribute details of their first patient with a new bladder cancer treated with TURBT after midnight of 31st January 2010.
  • Responses were received from 192 consultants.

Results

  • The median (range) time from referral to first Urology appointment was 11 (0–161) days, and the median (range) time from first appointment to TURBT was 27 (1–588) days.
  • In all, 12 (6.3%) patients underwent photodynamic diagnosis-assisted TURBT and 119 patients (61%) received a dose of Mitomycin C after TURBT.
  • The rate of major complications was low, with five incidences (2.6%) of bladder perforation.
  • There was no record of muscle present in resected specimens in 40 cases (20.8%) and resection was considered incomplete in 26 cases (13.5%). In all, 31 patients (16.1%) underwent early re-resection with residual tumour or carcinoma in situ detected in 17 cases, although no tumour was upstaged.
  • Of the 37 patients classified with intermediate-risk non-muscle-invasive bladder cancer (NMIBC), there were nine recurrences (24.3%) at 3 months, and 13 recurrences (35.1%) at 1 year. Newly presenting MIBC managed with currently available treatments has a high mortality rate of 33.3% at 1 year.

Conclusions

  • The quality of TURBT in the UK is high.
  • Areas for improvement include the timeliness of diagnosis and treatment, and improved care of patients with intermediate-risk NMIBC and MIBC.
  • The ‘snapshot’ methodology is promising but widening participation is a priority.