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Urological Surgery

Improving Practice Patterns in Patients with Newly Diagnosed Bladder Masses Treated with Transurethral Resection

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Introduction/Purpose: Presence of muscle on initial transurethral resection of bladder tumor (TURBT) specimen and performing a restaging transurethral resection (reTUR) within 6 weeks in high risk non-muscle invasive bladder cancer (NMIBC) aid in accurate staging and, therefore, guide proper treatment. The purpose of this study was to assess and improve TURBT quality by making surgeons aware of their practice patterns and setting improvement goals.

Methods or Case Description: Patients undergoing TURBT for a newly diagnosed bladder mass were analyzed during the 9 months before and after intervention. Primary endpoints were the presence of muscle on initial TURBT, and whether a reTUR was performed when clinically indicated. Initial results were presented to the physicians and a second dataset was then collected to assess for changes in practice patterns. Analysis was performed using Fisher's exact test to determine differences in categorical data. P< 0.05 was considered statistically significant.

Outcomes: After comparing the TURBT results before and after our quality improvement intervention, we found a significant improvement in the number of patients receiving a reTUR with 5/13 (38%) before compared to 15/19 (79%) after, P=0.03. The number of specimens on initial TURBT with muscle present were not significantly different with 38/52 (73%) before and 33/49 (67%) after. The average time to reTUR before and after QI intervention was 32.4 days and 42.4 days, respectively. 

Conclusion: Our data suggests critical analysis of practice patterns and setting improvement goals can significantly impact clinical practices. Future studies will be performed to determine the impact these changes have on oncologic outcomes.