scholarly journals Evaluation of Second-Look Transurethral Resection in Re-Staging of Patients With Superficial Bladder Cancer

2020 ◽  
Vol 18 (1) ◽  
pp. 16-22
Author(s):  
Md Masud Zaman ◽  
Md Sajid Hasan ◽  
Golam Mowla Chowdhury ◽  
Md Shafiqur Rahman ◽  
AKM Mahbubur Rahman
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Transurethral Resection ◽  
Treatment Strategy ◽  
Superficial Bladder Cancer ◽  
Bladder Tumour ◽  
Malignant Tissue ◽  
Second Look ◽  
Muscle Invasive ◽  
Initial Resection

Objective: The Objective of this study was to evaluate the second-look transurethral resection (TUR) from the base of the previously resected bladder tumour in avoidance of staging errors, possibility of changing treatment strategy, and determination of risk factors of up-staging in patients with a diagnosis of superficial bladder cancer. Materials and Methods: In this cross sectional study, 50 cases of superficial bladder cancers (pTa and pT1) were included where muscle coat were absent in histopathologic report of first TURBT. A second-look TUR from the tumour site were done after 4 weeks following the initial resection. At the second-look TUR, resection from the base of the previously resected area was performed for restaging. Finally, histopathologic findings of the second TURBT were compared with those of the initial one by appropriate statistical analysis. Results: Out of 50 patients, 27 (54%) had residual malignant tissue in histopathological report of second-look TUR, while 23 (46%) were tumour free (no residual malignant tissue) at second-look TUR. In this study, total up-staging of tumour found in 18 (36%) patients. Out of them, 6 (12%) and 2(4%) patients were up-staged from pTa to pT1 and PT2 respectively. 10 (20%) were up-staged from PT1 to muscle-invasive (pT2). So, total percentage of staging errors (under staging) detected in second-look TUR was 36% cases. Appearance (sessile), size (>3 cm) and stage (pT1) of the tumour at the initial resection were independent risk factors for up-staging to muscle invasive disease detected at second-look TURBT. Conclusions: Second-look TURBT is a valuable procedure for detection of residual tumour and accurate staging of non-muscle invasive bladder tumour. It also changed the treatment strategy of a significant proportion of patients. It is useful for tumours at high risk of recurrence and progression such as large size, sessile, multiple and T1 high grade tumours, particularly when there is inadequate or no muscularis propria in the specimen. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.16-22

scholarly journals A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer

2019 ◽  
Vol 7 (11) ◽  
pp. 4134
Author(s):  
Kishan K. Raj ◽  
Yogesh Taneja ◽  
Prateek Ramdev ◽  
Santosh K. Dhaked ◽  
Charan K. Singh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transurethral Resection ◽  
Prospective Observational Study ◽  
Residual Disease ◽  
Bladder Tumour ◽  
Detrusor Muscle ◽  
Residual Tumour ◽  
Muscle Invasive Bladder Cancer ◽  
T1 Stage ◽  
Muscle Invasive

Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of residual tumour and upstaging in NMIBC after TURBT and to investigate the risk factors for the same.Methods: A prospective observational study was carried out over 4 years and 87 patients were included in the study. Patients with NMIBC underwent RETURBT after 2-6 weeks of primary TURBT. The incidence of residual tumour and upstaging in RETUBRT was correlated with various histopathological and morphological parameters in primary TURBT.Results: Out of 87 patients, who underwent RETURBT, residual disease was present in 51 patients (58.6%) and upstaging occurred in 22 patients (25.2%).On univariate analysis, T1 stage (p=0.01), high grade (p=0.01), Carcinoma in situ(CIS) (p=0.01) and multifocality (p=0.05) were predictive for residual disease in RETURBT. High grade (p=0.01), CIS (p=0.01) and absence of detrusor muscle in specimen (p=0.03) were risk factors for upstaging in RETURBT.Conclusions: NMIBC have high incidence of residual disease and upstaging after primary TURBT. T1 stage, high tumour grade, CIS, and multifocality are risk factors for residual disease after primary TURBT. High tumour grade, CIS and absence of detrusor muscle are strongly associated with upstaging during RETURBT.

Routine preoperative group and save for TURP and TURBT – need and cost effectiveness

2017 ◽  
Vol 11 (1) ◽  
pp. 33-37
Author(s):  
Hazel Smith ◽  
Rachel Falconer ◽  
Justyna Szczachor ◽  
Sarfraz Ahmad
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
Blood Transfusion ◽  
Transurethral Resection ◽  
Bladder Tumour ◽  
Transurethral Resection Of Prostate ◽  
Junior Doctors ◽  
Two Samples ◽  
Muscle Invasive ◽  
One Year

Introduction: Standard practice in our unit is to take a group and save (G+S) blood sample for all patients undergoing a transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT). Modern studies show the transfusion rates for TURP are 2%–7% and for TURBT 2%. Aims: We will determine how many patients undergoing TURP and TURBT required blood transfusion, analyse the indication, timing and risk factors. Additionally we will assess the cost effectiveness of routine G+S. Methods: A retrospective analysis was conducted between 1 March 2015 and 29 February 2016 (one year). Patients were identified from OPERA database and cross-referenced with blood transfusion records. Electronic case notes for patients receiving transfusions were reviewed. Results: A total of 167 patients underwent TURP. Of these, 0.6% (1/167) received transfusion on day 4 post-op. A total of 160 patients underwent TURBT. Overall 3.8% (6/160) received transfusion: three patients on days 0–1 and three patients on days 2–30. All patients had pre-op Hb <100 g/l. All had large muscle-invasive tumours. Cost in our lab of a G+S sample is £23.52. Two samples are now required before blood can be issued. Discussion: Our study shows that risk factors for transfusion are large prostates, likely muscle-invasive bladder tumours and pre-op Hb <100 g/l. Other risks include coagulopathy. These will usually be identified by the surgeon or pre-assessment clinic prior to the procedure. Change in policy would save money and time of phlebotomists and junior doctors. Conclusions: Routine G+S is not necessary for all patients. Patients with risk factors can be identified preoperatively. This would give a potential saving of over £15,000 per year. This can be implemented without adversely affecting patient safety.

The importance of second-look transurethral resection for superficial bladder cancer

2014 ◽  
Vol 8 (5) ◽  
pp. 299-305
Author(s):  
Ehab El-Barky ◽  
Ahmed Sebaey ◽  
Magdy Eltabey ◽  
Ahmed Aboutaleb ◽  
Sundus Hussein ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Superficial Bladder Cancer ◽  
Second Look

Can urologists accurately stage and grade urothelial bladder cancer by assessing endoscopic photographs?

2017 ◽  
Vol 24 (9) ◽  
pp. 603-607 ◽  
Author(s):  
Snir Dekalo ◽  
Haim Matzkin ◽  
Nicola J Mabjeesh
Keyword(s):  
Bladder Cancer ◽  
Sensitivity And Specificity ◽  
Transurethral Resection ◽  
Bladder Tumour ◽  
Intravesical Therapy ◽  
Low Grade ◽  
Tumour Stage ◽  
Urothelial Bladder Cancer ◽  
Urothelial Bladder ◽  
Muscle Invasive

Introduction Assessment of urothelial bladder cancer during cystoscopy or transurethral resection of bladder tumour has a significant impact on the urologist's decision-making: treatment with simple outpatient fulguration, required depth of resection, and need of immediate post-surgical intravesical therapy. These choices depend heavily on the urologist's ability to accurately assess pre-biopsy tumour stage and grade. The aim of the study was to determine whether evaluation of photographs taken during transurethral resection of bladder tumour can reliably characterize a tumour’s stage and grade. Methods Smartphone photographs of 50 urothelial bladder cancer cases were taken at the beginning of transurethral resection of bladder tumour and individually presented to seven senior urologists. All urologists were blinded to the final pathological report and to any other urological evaluation. Each one was asked to rate the tumour as low vs high grade and noninvasive Ta vs noninvasive T1 or muscle invasive. Results were compared with final pathology. Individual appraisal and the majority's opinion were evaluated. Results Urologists have correctly predicted tumour stage and grade in 63.5% of cases (222 of 350, average of 32 out of 50 accurate assessments). The final majority assessment was correct in 40 of 50 cases (80%). Sensitivity and specificity of the final results for the diagnosis of T1 or higher were 80% and 88.6%, respectively. Sensitivity and specificity for Ta low grade were 83.3% and 80%, respectively. Conclusions To the best of our knowledge, this is the first documented attempt to evaluate urologists' ability to assess urothelial bladder cancer stage and grade using endoscopic photographs. Urologists can usually identify stage and grade of urothelial bladder cancer but accuracy increases when multiple senior urologists examine the same photographs and achieve majority consensus. Presenting photographs of urothelial bladder cancer to a team of urologists may lead to an excellent decision regarding type and extent of surgical treatment and substantiate appropriate post-surgical management.

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