Quality Control Indicators for Transurethral Resection of Bladder Tumor: Results from an Embedded Belgian Multicenter...

Area of Science:

• Urology
• Oncology
• Quality Improvement

Background:

• Quality control indicators (QCIs) enable objective evaluation of guideline adherence in urology.
• Assessing QCIs for non-muscle-invasive bladder cancer (NMIBC) is crucial for standardizing care.

Purpose of the Study:

• To evaluate six key QCIs for NMIBC using a prospective registry of transurethral resection of bladder tumor (TURBT) procedures.
• To assess QCI compliance, reporting quality, and correlation with recurrence-free survival (RFS).

Main Methods:

• Prospective collection of TURBT data via electronic case report forms (eCRFs) across three centers (2013-2017).
• Retrospective pathological data collection; exclusion of T0 and prior T2 disease.
• Assessment of six QCIs: complete resection, detrusor muscle presence, re-TURBT, mitomycin C (MMC) instillation, bacillus Calmette-Guérin (BCG) therapy, and timely treatment initiation.

Main Results:

• 1151 TURBT procedures from 907 patients were analyzed.
• Reporting quality was suboptimal for detrusor muscle (35%) and BCG (51%).
• Compliance varied: CR (97%), DM (31%), MMC (65%), re-TURBT (33%), BCG (39%), therapy ≤6 wk (88%).
• Center-specific compliance differences were significant; MMC and re-TURBT compliance increased over time.
• MMC compliance correlated significantly with RFS.

Conclusions:

• A TURBT registry with eCRFs is feasible for assessing NMIBC QCIs in real-world settings.
• Inter-center variations in QCI performance can drive improvements in urologist care.
• Enhanced QCI monitoring can potentially improve clinical outcomes for NMIBC patients.