Abstract
Introduction The presence of detrusor muscle (DM) is an essential component in “complete” transurethral resection of bladder tumour (TURBT) specimen. This study analyses patients who were subjected to a “complete” first TURBT to determine the presence/absence of DM in the specimen. Methodology Newly diagnosed non-muscle invasive bladder cancer (NMIBC) from 1-April-2007 to 31-March-2017(10-years) were retrospectively analysed at National Hospital of Sri Lanka. All TURBTs performed at initial diagnosis were analysed to determine the presence of DM in the specimen, the recurrence rate at first check cystoscopy (FCC) at 3 months and the association with surgeon's experience. Results Of 181 TURBT, 99(54.7%) were done by Consultant Urological Surgeon (CUS) and 82(45.3%) by senior registrars (SR). The overall DM positivity rate was 59.7% (n= 108/181), for CUS: 63.6% (n=63/99) and SRs 54.9% (n=45/82) (p=0.232); for pTa tumours:-CUS: 46.5%vs.SRs:50 %( p=0.751) and for pT1 tumours:-CUS: 76.8%vs.SRs:59.5 %( p=0.067). Analysis of those who were followed up (145/181, 80.1%) showed a positive recurrence at FCC in 27.1 %( 23/85) and 30.0 %( 18/60) when DM was present and absent in the first TURBT specimen respectively (OR=0.87(95%-CI: 0.41-1.8, p=0.7). Conclusion Clinically, DM positivity rate has prognostic significance only in the pT1 category of NMIBC. For pT1 tumours, the positive DM rates for the CUS and SRs were 76.8% and 59.5% respectively. The indifference in the recurrence rate may be due to the considerable proportion of lost to follow up in our study. Nevertheless, measures should be taken to enhance the DM positivity rates among urologists to achieve accurate staging and better prognosis.
Highlights
The presence of detrusor muscle (DM) is an essential component in “complete” transurethral resection of bladder tumour (TURBT) specimen
The Sri Lanka Journal of Surgery 2020; 38(1): 22-27 may be due to the considerable proportion of lost to follow up in our study
The uropathologist should state the stages as pTx in the absence of detrusor muscle (DM) in the TURBT specimen, when there is presence of tumour in the lamina propria, emphasising the requirement to perform a restaging TURBT
Summary
The presence of detrusor muscle (DM) is an essential component in “complete” transurethral resection of bladder tumour (TURBT) specimen. Bladder malignancies are the fourth commonest male cancers worldwide[1]. Bladder cancer is common among Sri Lankan males and seen among females [2,3]. A complete TURBT in non-muscle invasive bladder cancer (NMIBC) should encompass (i) resection of all visible tumour(s) (ii) resection of apparently normal mucosa (~1cm) on the border of the tumour, and (iii) resection of part of the detrusor muscle (muscularis propria) at the tumour base [6]. The uropathologist should state the stages as pTx in the absence of detrusor muscle (DM) in the TURBT specimen, when there is presence of tumour in the lamina propria (i.e. pT1 or higher), emphasising the requirement to perform a restaging TURBT. NMIBC can quite confidently be reported only when DM present in the specimen is uninvolved by urothelial bladder cancer
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