BERKELEY, CA (UroToday.com) - The initial diagnosis of a suspected bladder tumor is confirmed by the pathological examination of tissue obtained during transurethral resection. Although video endoscopy has accelerated learning, teaching transurethral resection of bladder tumors (TURBT) can be difficult. It is difficult to describe the appropriate depth or pressure required to completely resect a bladder tumor. Nevertheless, all residents who attain endoscopic proficiency start their training endoscopically naive. There is sparse data that has described the complications of TURBT during the initial part of this learning curve.

To examine the incidence of intraoperative and postoperative complications during TURBTs performed by residents and fellows under direct attending supervision, a database was constructed on 173 consecutive patients undergoing the procedure in the University of Miami residency program. The report, by A. M. Nieder and Mark Soloway and colleagues, is published in the December 2005 issue of the Journal of Urology.

For each procedure, resident and fellow participation was determined by the supervising faculty member based on individual endoscopic skills, level of training, and difficulty of the operative procedure. A data sheet was completed for each patient at the time of TURBT which recorded all cystoscopic findings, number of previous TURBTs, number of and location of tumors, catheter use, and intraoperative bladder perforations. At discharge, an additional entry was made concerning postoperative complications.

The mean age of the patient was 67 years, mean operating room time was 39 minutes, the majority (42%) had one tumor resected, and 91% had a urethral catheter placed post-operatively for a mean of 1.7 days. A total of 10 (5.8%) patients had an intraoperative or postoperative complication. There were 6 (3.5%) bladder perforations, 2 intraperitoneal and 4 extraperitoneal. All 4 extraperitoneal perforations were managed conservatively with catheter drainage as was one of the intraperitoneal perforations. All patients did well including the one intraperitoneal perforation that underwent a radical cystectomy shortly thereafter. One intraperitoneal perforation required immediate abdominal exploration for bleeding. He subsequently was discharged but returned 9 months later with a bowel obstruction and eventually died of sepsis. The four extraperitoneal injuries were performed by residents in their first or third year of residency while the two intraperitoneal perforations occurred during procedures performed by a chief resident (PGY 5) or a fellow (PGY-7).

The authors show by this review that TURBT can be safely performed by residents in training with minimal morbidity on par with other published series of the procedure performed by practicing urologists. The complications seen in this series show that contrary to expected findings, more senior trainees were involved in the complications, likely secondary to their disproportionate roles in more difficult resections. Upon review of the data, the authors were unable to identify any patient or tumor characteristic that increased the risk of a complication.

J Urol. 2005 Dec;174(6):2307-9