scholarly journals A retrospective analysis of the factors associated with increased risk of readmission within 30 days following primary transurethral resection of bladder tumour

2021 ◽  
Author(s):  
tarun jindal ◽  
Ankush Sarwal ◽  
Prateek Jain ◽  
Rajan Koju ◽  
Satyadip Mukherjee
Keyword(s):  
Transurethral Resection ◽  
Tumour Size ◽  
Bladder Tumour ◽  
Unplanned Readmission ◽  
Perioperative Morbidity ◽  
Anti Platelet Agent ◽  
Invasive Tumour ◽  
Increased Risk ◽  
History Of ◽  
Muscle Invasive

Background Transurethral resection of bladder tumour (TURBT) is associated with a perioperative morbidity of 5-10% which can lead to unplanned readmissions. In this study, we aim to identify factors that lead to an increased risk of unplanned readmissions within 30 days of primary TURBT. Methods A retrospective study was conducted to identify patients who had their primary TURBT at our institute from 2011-2019. The clinico-demographic factors, history of smoking, intake of anti-platelet drugs, co-morbidities, tumour size (< 3 cm or > 3cm), multifocality and histopathological type were abstracted. The patients who had a readmission were identified and reasons for admission were recorded. Results A total of 435 patients were identified. The median age was 66 years. There were 378 (86.9%) males, 110 (25.3%) had history of smoking and 37 (8.5%) had history of intake of an anti-platelet agent. In the cohort 166 (38.2%) were diabetic, 239 (54.9%) were hypertensive, 72 (16.6%) had COPD, 78 (7.9%) had hypothyroidism. A total of 206 (47.4%) had a tumour of >3cm, multifocality was seen in 140 (32.2%) while muscle invasive tumour was present in 161 (37%) patients. A total of 22 (5.06%) had re-admissions within 30 days with hematuria being the commonest etiology. On the univariate and multivariate analysis, history of smoking ( p=0.006 and 0.008, respectively) or intake of anti-platelet agents (p<0.001 and <0.001, respectively) were significantly associated with increased unplanned readmission. Conclusion Our study revealed smoking and intake of anti-platelet agents as the factors leading to increased risk of unplanned readmissions.

scholarly journals A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer

2019 ◽  
Vol 7 (11) ◽  
pp. 4134
Author(s):  
Kishan K. Raj ◽  
Yogesh Taneja ◽  
Prateek Ramdev ◽  
Santosh K. Dhaked ◽  
Charan K. Singh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transurethral Resection ◽  
Prospective Observational Study ◽  
Residual Disease ◽  
Bladder Tumour ◽  
Detrusor Muscle ◽  
Residual Tumour ◽  
Muscle Invasive Bladder Cancer ◽  
T1 Stage ◽  
Muscle Invasive

Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of residual tumour and upstaging in NMIBC after TURBT and to investigate the risk factors for the same.Methods: A prospective observational study was carried out over 4 years and 87 patients were included in the study. Patients with NMIBC underwent RETURBT after 2-6 weeks of primary TURBT. The incidence of residual tumour and upstaging in RETUBRT was correlated with various histopathological and morphological parameters in primary TURBT.Results: Out of 87 patients, who underwent RETURBT, residual disease was present in 51 patients (58.6%) and upstaging occurred in 22 patients (25.2%).On univariate analysis, T1 stage (p=0.01), high grade (p=0.01), Carcinoma in situ(CIS) (p=0.01) and multifocality (p=0.05) were predictive for residual disease in RETURBT. High grade (p=0.01), CIS (p=0.01) and absence of detrusor muscle in specimen (p=0.03) were risk factors for upstaging in RETURBT.Conclusions: NMIBC have high incidence of residual disease and upstaging after primary TURBT. T1 stage, high tumour grade, CIS, and multifocality are risk factors for residual disease after primary TURBT. High tumour grade, CIS and absence of detrusor muscle are strongly associated with upstaging during RETURBT.

scholarly journals Vesical nephrogenic adenoma: an unusual presentation of a bladder tumour

2013 ◽  
Vol 5 (5) ◽  
pp. 79
Author(s):  
Carlos Martínez-Sanchíz ◽  
Jesús Martínez-Ruiz ◽  
Pedro J. Anguita-Fernandez ◽  
José M. Giménez-Bachs ◽  
Manuel Atiénzar-Tobarra ◽  
...  
Keyword(s):  
Kidney Stones ◽  
Transurethral Resection ◽  
Foreign Bodies ◽  
Bladder Tumour ◽  
Tubular Structures ◽  
Bacille Calmette Guerin ◽  
Nephrogenic Adenoma ◽  
Urological Surgery ◽  
Voiding Symptoms ◽  
History Of

Vesical nephrogenic adenoma is a rare, benign entity that appearsmost commonly in middle-aged males. Its etiology is unknown,but it has been linked to chronic irritating factors, such as infection,trauma, urological surgery, kidney stones, foreign bodies andchemical agents, such as Bacille Calmette-Guerin. We report 2new cases with a history of transurethral resection of the bladderand the prostate and a history of prolonged voiding symptoms. Inboth cases, the findings of encysted tubular structures lined withflattened cuboidal cells without atypia were consistent with thediagnosis of vesical nephrogenic adenoma.

Routine preoperative group and save for TURP and TURBT – need and cost effectiveness

2017 ◽  
Vol 11 (1) ◽  
pp. 33-37
Author(s):  
Hazel Smith ◽  
Rachel Falconer ◽  
Justyna Szczachor ◽  
Sarfraz Ahmad
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
Blood Transfusion ◽  
Transurethral Resection ◽  
Bladder Tumour ◽  
Transurethral Resection Of Prostate ◽  
Junior Doctors ◽  
Two Samples ◽  
Muscle Invasive ◽  
One Year

Introduction: Standard practice in our unit is to take a group and save (G+S) blood sample for all patients undergoing a transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT). Modern studies show the transfusion rates for TURP are 2%–7% and for TURBT 2%. Aims: We will determine how many patients undergoing TURP and TURBT required blood transfusion, analyse the indication, timing and risk factors. Additionally we will assess the cost effectiveness of routine G+S. Methods: A retrospective analysis was conducted between 1 March 2015 and 29 February 2016 (one year). Patients were identified from OPERA database and cross-referenced with blood transfusion records. Electronic case notes for patients receiving transfusions were reviewed. Results: A total of 167 patients underwent TURP. Of these, 0.6% (1/167) received transfusion on day 4 post-op. A total of 160 patients underwent TURBT. Overall 3.8% (6/160) received transfusion: three patients on days 0–1 and three patients on days 2–30. All patients had pre-op Hb <100 g/l. All had large muscle-invasive tumours. Cost in our lab of a G+S sample is £23.52. Two samples are now required before blood can be issued. Discussion: Our study shows that risk factors for transfusion are large prostates, likely muscle-invasive bladder tumours and pre-op Hb <100 g/l. Other risks include coagulopathy. These will usually be identified by the surgeon or pre-assessment clinic prior to the procedure. Change in policy would save money and time of phlebotomists and junior doctors. Conclusions: Routine G+S is not necessary for all patients. Patients with risk factors can be identified preoperatively. This would give a potential saving of over £15,000 per year. This can be implemented without adversely affecting patient safety.

scholarly journals Comparison of three different antibiotic protocols in transurethral resection of bladder tumour and the possible infectious risk factors: A non-randomized, prospective study

2018 ◽  
Vol 12 (11) ◽  
Author(s):  
Jorge Panach-Navarrete ◽  
Lorena Valls-González ◽  
Eduardo Sánchez-Cano ◽  
María Medina-González ◽  
Ana Castelló-Porcar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Transurethral Resection ◽  
Urinary Catheter ◽  
Bladder Tumour ◽  
Infectious Complications ◽  
Infectious Risk ◽  
Increased Risk ◽  
Group A ◽  
Long Protocol

Introduction: We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery.Methods: We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered.Results: A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5ºC (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02).Conclusions: Those patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.

scholarly journals Cautery artifact understages urothelial cancer at initial transurethral resection of large bladder tumours

2017 ◽  
Vol 11 (5) ◽  
pp. 203 ◽  
Author(s):  
Matthew Truong ◽  
Lorraine Liang ◽  
Janet Kukreja ◽  
Jeanne O’Brien ◽  
Jerome Jean-Gilles ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Urothelial Cancer ◽  
Tumour Size ◽  
Accurate Determination ◽  
Bladder Tumour ◽  
Billing Data ◽  
Accurate Staging ◽  
Resident Involvement ◽  
Bladder Tumours

Introduction: We sought to determine how frequently cautery (thermal) artifact precludes an accurate determination of stage at initial transurethral resection of bladder tumour (TURBT) of large bladder tumours.Methods: We queried our institution’s billing data to identify patients who underwent TURBT for large bladder tumours >5cm (CPT 52240) by two urologists at an academic centre from January 2009 through April 2013. Only patients who underwent initialstaging TURBT for urothelial cancer were included. Pathological reports were reviewed for stage, number of separate pathological specimens per TURBT, and presence of cautery artifact. Operative reports were reviewed for whether additional cold cup biopsies were taken of other suspicious areas of the bladder, resident involvement, and type of electrocautery.Results: We identified 119 patients who underwent initial staging TURBT for large tumours. Cautery artifact interfered with accurate staging in 7/119 (6%) of cases. Of these, six patients underwent restaging TURBT, with 50% percent experiencing upstaging to T2 disease. Tumour size, tumour grade, whether additional cold cup biopsies were taken, number of separate pathological specimens sent, and resident involvement were not associated with cautery artifact (all p>0.05). Bipolar resection had a higher rate of cautery artifact 5/42 (12%), compared to monopolar resection 2/77 (2.6%) approaching significance (p=0.095).Conclusions: Cautery artifact may delay accurate staging at initial TURBT for large tumours by understaging up to 6% of patients.

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