In the UK, one in two patients with bladder cancer will require a second transurethral resection (TUR) and approximately one in two patients will have tumour on re-TUR, according to the findings of an audit on the quality of TUR of bladder tumours (TURBT) across the country.
The 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 included the presence of detrusor in the specimen, rate of re-TUR, presence of carcinoma in situ and three-month recurrence rates. Adherence to guidelines on the management of non-muscle invasive bladder cancer was evaluated.
The data revealed that detrusor muscle was absent in specimens taken at the initial TURBT in 22.8 per cent of cases. The chance of including muscle in the specimen quadrupled for tumours larger than 3 cm.
Single immediate chemotherapy instillations after TURBT are underutilised and was administered in only 40 per cent of eligible patients.
Just over 54 per cent of patients had a re-TUR, which was carried out on average 10 weeks after initial TURBT.
The three-month recurrence rate was 36.0 per cent with tumours >3 cm. Early recurrences were not affected by intravesical instillations with bacillus Calmette-Guérin or mitomycin C.
The authors say the findings demonstrate that it is important to inform patients with new bladder tumours that there is a considerable chance they will need to have a second operation within the following weeks.
“Equally important is to try and list patients for re-TUR as soon as possible, especially those with large (>3 cm) tumors, given the significant delay in re-TUR shown in our study,” they add.