Improving practice patterns in patients with newly diagnosed bladder masses treated with transurethral resection

Area of Science:

• Urology
• Oncology
• Surgical Quality Improvement

Background:

• Transurethral resection (TUR) is standard for nonmuscle invasive bladder cancer (NMIBC) diagnosis and treatment.
• Inadequate muscle in initial TURBT specimens (iTURBT) leads to understaging and poorer outcomes.
• Repeat TURBT (reTURBT) within 6 weeks improves staging accuracy for high-risk NMIBC.

Purpose of the Study:

• To assess and enhance TURBT quality through surgeon awareness of practice patterns.
• To implement quality improvement (QI) goals for bladder cancer treatment.

Main Methods:

• Retrospective and prospective chart review of 101 patients undergoing TURBT for newly diagnosed bladder masses.
• Data collected on muscle presence in iTURBT, risk stratification, and reTURBT indications and timing.
• QI intervention involved physician education on initial performance, followed by a 9-month prospective assessment.

Main Results:

• A significant increase in indicated reTURBT was observed post-QI intervention (38.5% to 78.9%, p=0.03).
• Muscle presence in iTURBT specimens did not significantly change (73.1% to 67.3%, p=0.66).
• The time to reTURBT did not significantly differ between pre- and post-QI periods (p=0.28).

Conclusions:

• Physician practice pattern analysis and education can significantly improve clinical practices.
• QI interventions can enhance the quality of care in bladder cancer management.
• Further studies are needed to evaluate the impact on oncologic outcomes.