Evaluation of Factors Affecting Transurethral Bladder Tumor Resection Quality: A Single-center Study Including 1014 Procedures

Objectives: The quality of transurethral resection of bladder tumor (TURBT) significantly affects disease management. Pathology specimens that do not contain detrusor muscle (DM) may be associated with low clinical staging. The aim of this study was to evaluate the factors affecting the detection of DM in TURBT.
Methods: A total of 1014 patients who underwent TURBT between June 2016 and June 2024 and met the inclusion criteria were enrolled in the study. The requirements for good-quality TURBT were complete resection and detection of DM in the pathology specimen. All procedures were performed by a total of 17 residents under the supervision of a specialist doctor.
Results: DM was obtained statistically significantly more often in patients with large (≥3 cm), multiple, and solid tumors. In addition, DM was observed more frequently in the pathology specimens of patients with high-grade tumors, variant histology (VH), or accompanying carcinoma in situ (CIS). The effect of surgical experience on obtaining DM was evaluated, and senior residents (4th year and final year) were found to be more successful than junior residents (3rd year) (65.3% vs. 58%, p=0.021). Multivariate analysis revealed that tumor architecture and tumor size were significant factors influencing DM acquisition.
Conclusion: Surgical success in the TURBT procedure has not been clearly defined, but it is known to be affected by many factors. In our study, the rate of DM detection was found to be lower in low-risk tumors. Increasing experience during urology residency was associated with higher-quality TURBT outcomes.

Keywords: Bladder cancer, detrusor muscle, resident training, surgical experience, TURBT