Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal.
Servicio de Urología, Hospital Universitario de São João, Oporto, Portugal; Facultad de Medicina, Universidad de Oporto, Oporto, Portugal.
Actas Urol Esp (Engl Ed). 2024 Jul-Aug;48(6):448-453. doi: 10.1016/j.acuroe.2023.12.007. Epub 2023 Dec 29.
Transurethral resection of bladder tumor (TURBT) is crucial in the treatment of bladder tumors and when incorrectly performed can cause staging mistakes. To avoid these errors, a second resection is recommended in selected cases. The aim of this study is to evaluate the surgeon's ability to predict histologically complete primary resection of newly diagnosed bladder tumors avoiding the need for a second TURBT.
This is a prospective, observational study involving 47 consecutive patients with newly diagnosed bladder tumors who had previously undergone primary TURBT, and met EAU criteria for second-look TURBT. Second-look TURBT specimens were analyzed for routine histological assessment and compared with the surgeon's impression of the tumor at initial resection.
Of 91 patients submitted to primary TURBT, 47 met the criteria for second-look TURBT. Second-look specimens revealed residual disease in 20.9% of patients and 3 (6.4%) of patients showed upstaging disease. The sensitivity of a senior to detect disease on second-look TURBT in relation to muscle invasion was 75%, and the specificity was 85%.
Second-look TURBT is crucial in the treatment of bladder cancer and cannot be replaced by a surgeon's opinion, so international recommendations should be followed. Supervision of less experienced surgeons is a cornerstone.
经尿道膀胱肿瘤切除术（TURBT）对膀胱肿瘤的治疗至关重要，如果操作不当，可能会导致分期错误。为了避免这些错误，建议在某些情况下进行二次切除。本研究旨在评估外科医生在避免需要二次 TURBT 的情况下预测新诊断的膀胱肿瘤初次切除组织学完全的能力。
这是一项前瞻性、观察性研究，涉及 47 例先前接受过初次 TURBT 且符合 EAU 标准行二次 TURBT 的新诊断膀胱肿瘤患者。对二次 TURBT 标本进行常规组织学评估，并与外科医生初次切除时对肿瘤的印象进行比较。
在 91 例接受初次 TURBT 的患者中，47 例符合二次 TURBT 的标准。二次 TURBT 标本显示 20.9%的患者有残留疾病，3 例（6.4%）患者有升级疾病。高级别外科医生在二次 TURBT 中检测到肌层浸润性疾病的敏感性为 75%，特异性为 85%。
二次 TURBT 在膀胱癌的治疗中至关重要，不能被外科医生的意见所替代，因此应遵循国际建议。对经验较少的外科医生进行监督是一个基石。
