To assess whether improvements in transurethral resection of bladder tumour (TURBT) quality achieved during the RESECT international study (ClinicalTrials.gov identifier: NCT05154084) were sustained over time following completion of the programme at our institution and to investigate their effect on disease recurrence.
We conducted a prospective, observational monocentric cohort study at a tertiary university hospital. A total of 128 consecutive patients undergoing TURBT between March 2023 and June 2025 and meeting RESECT eligibility criteria were analysed. Four pre-defined surgical quality indicators-detrusor muscle sampling, completeness of resection, accuracy of operative documentation, and administration of single immediate intravesical chemotherapy (SI-IVC)-were compared across three institutional phases: pre-audit, prospective audit and post-audit RESECT periods. Recurrence-free survival (RFS) at follow-up was evaluated by cystoscopy and histological confirmation with TURBT.
Detrusor muscle presence improved from 61.9% in the pre-audit phase to 70.7% during the prospective audit and 85.9% post-audit (P < 0.001). Completeness of resection documentation increased from 88.4% to 96.3% and 97.6%, respectively (P < 0.001), while documentation accuracy remained high across all phases (93.2%, 96.3%, and 96.1%). SI-IVC use rose from 0% in the first two phases to 25% after audit closure. Despite these improvements, RFS did not differ significantly between phases.
Participation in a service-wide audit and feedback programme resulted in sustained improvements in TURBT surgical quality indicators after programme completion. This did not yield a detectable reduction in recurrence, highlighting the multifactorial nature of oncological outcomes in non-muscle-invasive bladder cancer. Further studies are required to identify which quality metrics most strongly influence long-term prognosis.
BJU international. 2026 Apr 01 [Epub ahead of print]
Luca Orecchia, Marco Gerardi, Gaia Colalillo, Federico De Leonardis, Eleonora Rosato, Anastasios D Asimakopoulos, Kevin M Gallagher, Nikita Bhatt, Sinan Khadhouri, Veeru Kasivisvanathan, Enrico Finazzi Agrò, Roberto Miano, Simone Albisinni
Urology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy., Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK., Department of Urology, St Vincent's University Hospital, Dublin, Ireland., Department of Urology, School of Medicine, University of St Andrews, St Andrews, UK., Division of Surgery and Interventional Science, University College London, London, UK.