Assessment of the infiltrative character of bladder cancer at the time of transurethral resection: a single center study

Introduction: Determining the clinical stage of bladder carcinoma before radical cystectomy is characterized by a high inaccuracy rate. The discrepancy in some reports reaches up to 48%. Therefore intraoperative clinical staging of bladder carcinoma is not recommended before radical treatment as it is for prostate cancer. However, the accuracy of clinical assessment of the muscle invasive character of the tumors at the time of transurethral resection has not been studied. In our study we estimate the accuracy of clinical staging during endoscopic treatment.

Material and methods: 332 patients who had undergone transurethral resection of bladder cancer were studied in this retrospective analysis. Data such as age, gender, presence of hydronephrosis, operator, the results of bimanual bladder examination, TURB report and pathologic report, were collected from each patient. Intraoperative prediction of the muscle invasive nature of the tumor was compared with pathological reports. A logistic regression analysis was used to evaluate the influence of particular variables on upstaging and downstaging.

Results: Overall accuracy between clinical and histopathology staging was 87.8%. Discrepancy was observed only in 36 patients. Patients with pTa stage were the most numerous group among patients with accurate prediction of the muscle invasiveness character of the tumor. Univariable logistic regression indicated that the presence of a palpable mass in the bimanual examination was a predictor of upstaging, with an OR 11.75 CI95% [2.49-55.32].

Conclusions: The study indicated the high accuracy between clinical and pathological reports. Intraoperative evaluation of tumor character should be an indispensable part of treatment, which can be useful for planning in advance the further stages of treatment.