Day case primary trans-urethral resection of bladder tumour (TURBT) as standard in a single UK centre. Should this be the new norm?

Abstract

Objectives:

A retrospective study was conducted to examine the feasibility and safety of performing trans-urethral resection of bladder tumour (TURBT) in newly diagnosed patients as a day case operation.

Patients and methods:

All patients who underwent a primary TURBT over a 12 month period were included. Data were collected on patient demographics, tumour characteristics, day case vs. inpatient admission, indications for inpatient admission, re-admission rates within 28 days, and surrogate markers for quality of resection including recurrence rates.

Results:

A total of 172 patients were included. TURBT was performed as a day case procedure on 138 patients (80.2%). Rates of re-admission within 28 days were 7.2% and 5.9% in the day case and inpatient cohorts respectively. One hundred and thirty (75.6%) patients had non-muscle invasive bladder cancer (NMIBC). Of these, 84 (64.6%) were found to have detrusor muscle in their specimens, and 86 (66.2%) received peri-operative mitomycin C. Twelve month recurrence rates were 12%, 27% and 33% for low, intermediate and high-risk NMIBC respectively.

Conclusion:

This study shows that day case surgery for TURBT is feasible in the majority of patients, with a low rate of re-admission. Our data suggest that day case TURBT is suitable as standard practice in our institution and should be considered by others.

Level of evidence:

2b.

Keywords

Bladder cancer trans-urethral resection of bladder tumour (TURBT)day case recurrence re-admission rates

Get full access to this article

View all access options for this article.

References

Office for National Statistics. Cancer Registration statistics, England: 2016, https://www.ons.gov.uk/releases/cancerregistrationstatisticsengland2016 (2018, accessed 01 August 2019).

NHS England. Next steps on the NHS Five Year Forward View. https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/ (2017, accessed 01 August 2019).

Bailey

Ahuja

Bartholomew

, et al. Guidelines for day-case surgery 2019. Anaesthesia 2019; 74: 778–792.

NHS Modernisation Agency. 10 High impact changes for service improvement and delivery. Best practice guidelines, https://www.england.nhs.uk/improvement-hub/publication/10-high-impact-changes-for-service-improvement-and-delivery/ (2017, accessed 01 August 2019).

Kockelbergh

Transurethral resection of bladder tumour: is day-case surgery appropriate?

BJU Int 2005; 96: 746–747.

Babjuk

Böhle

Burger

, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 2017; 71: 447–461.

National Institute for Health and Care Excellence. Bladder cancer: diagnosis and management. NICE guideline 2, https://www.nice.org.uk/guidance/ng2/resources/bladder-cancer-diagnosis-and-management-pdf-51036766405 (2015, accessed 01 August 2019).

Mariappan

Zachou

Grigor

Detrusor muscle in the first apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence and is dependent on operator experience. Eur Urol 2010; 57: 843–849.

Shoshany

Mano

Margel

, et al. Presence of detrusor muscle in bladder tumour specimens – predictors and effect on outcome as a measure of resection quality. Urol Oncol 2014; 32: 17–22.

10.

Herr

Donat

A re-staging transurethral resection predicts early progression of superficial bladder cancer. BJU Int 2006; 97: 1194–1198.

11.

Pandit

Davies

Are day surgery units collecting ‘readmission rate’ data?

JODS 2006; 15: 77–79.

12.

Harrison

Urology, GIRFT programme national speciality report, https://gettingitrightfirsttime.co.uk/urology-report/ (2018, accessed 01 August 2019).

13.

Balbay

Cementepe

Unsal

, et al. The actual incidence of bladder perforation following transurethral bladder surgery. J Urol 2005; 174: 2260–2263.

14.

Collado

Chechile

Salvador

, et al. Early complications of endoscopic treatment for superficial bladder tumors. J Urol 2000; 164: 1529–1532.

15.

Nieder

Meinbach

Soloway

, et al. Transurethral bladder tumour resection: intraoperative and postoperative complications in a residency setting. J Urol 2005; 174: 2307–2309.

16.

Hollenbeck

Miller

Taub

, et al. Risk factors for adverse outcomes after transurethral resection of bladder tumours. Cancer 2006; 106: 1527–1535.

17.

Brausi

Collette

Kurth

, et al. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol 2002; 41: 523–531.

18.

Mariappan

Smith

Lamb

, et al. Pattern of recurrence changes in noninvasive bladder tumors observed during 2 decades. J Urol 2007; 177: 867–875.

19.

Sylvester

van der Meijden

Oosterlinck

, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006; 49: 466–477.