The Learning Curve for Transurethral Resection of Bladder Tumour: How Many is Enough to be Independent, Safe and Effective Surgeon?

Transurethral resection of the bladder tumour (TURBT) is one the most common urological procedures. It is also one the fundamental surgeries performed by residents. The learning curve (LC) for TUR has never been analysed. The aim of the study was to analyse the learning curve of TURBT in a residency setting.

This retrospective multicentre analysis of prospectively maintained databases enrolled 993 consecutive TURBTs performed by 10 urology residents in 3 academic institutions. Study end-points were as follows: the absence of muscularis propria in a specimen, any intra- or postoperative surgical complication and 3-month recurrence-free survival.

With increasing experience, residents operated more complex cases defined by higher rate of large, multifocal or high-risk tumours. In the same time, surgery time, postoperative catheterization time and hospital stay became shorter. An improvement has been noticed regarding the muscularis propria sampling and 3-month recurrence-free survival, but not regarding the risk of surgical complications. Evident improvement in study end-points was noticed after 101 operations; surgeons achieved the best clinical outcomes after performing 170 procedures, whereas the poorest results for the first 45 operations.

TURBT has a flat LC with 100 cases being the absolute minimum for a resident in training to achieve acceptable oncological and surgical outcomes.

Journal of surgical education. 2020 Mar 05 [Epub ahead of print]

Sławomir Poletajew, Wojciech Krajewski, Krystian Kaczmarek, Bartłomiej Kopczyński, Remigiusz Stamirowski, Andrzej Tukiendorf, Romuald Zdrojowy, Marcin Słojewski, Piotr Radziszewski

Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland., Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland. Electronic address: ., Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland., Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland., Social Medicine Department, Wrocław Medical University, Wrocław, Poland., Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland.