Impact of a teaching program on outcome quality of white light transurethral resection for bladder tumor: A cohort study

Abstract

Objective: To test the hypothesis that a teaching program improves the quality of transurethral resection of bladder tumor(TURBT) and decreases the risk of early recurrence.

Material and methods: This is an observational retrospective cohort study of prospectively recorded data of patients withfirst clinical diagnosis of non-muscle-invasive bladder cancer (NMIBC), scheduled for TURBT. In 2005 a systematic TURBTteaching program was introduced in our Department. We reviewed the charts of patients who underwent TURBT in the years1998-2004, when no tutoring was applied, and those who underwent TURBT in the years 2005-2010. The outcomes of interestwere: presence/absence of detrusor muscle (DM), carcinoma in situ (CIS) detection, complication rate and recurrence rate at thefirst follow-up cystoscopy (RRFF-C).

Results: Complete data from 427 patients were available: 199 before and 228 after the introduction of the teaching program.Multivariable logistic analysis showed that the training program was an independent prognostic factor for DM (presence) rate(OR = 3.92, 95%CI = 2.42-6.33), CIS detection rate (OR = 4.36, 95%CI = 1.92-9.86), and complication rate (OR = 0.28, 95%CI= 0.15-0.55), but not for RRFF-C (OR = 0.79, 95%CI = 0.52-1.20). Between 1998-2004, RRFF-C was correlated with tumornumber, pathological stage, DM presence, presence of complication, CIS detection and surgeon experience. After the introductionof the teaching program, only tumor number, DM presence and surgeon experience influenced the RRFF-C.

Conclusion: Our findings suggest the hypothesis that the teaching program might have an impact of quality of TURBT, but itfailed to improve the RRFF-C.