title: "Complete transurethral resection of bladder tumor": are the guidelines being followed?
abstract: OBJECTIVE
  To determine how often complete eradication of all visible tumors during transurethral resection of bladder tumor (TURBT) is accomplished in a referral setting. The American Urological Association guidelines recommend complete eradication whenever possible.
  
  
  METHODS
  We retrospectively reviewed the records of patients who underwent a second TURBT within 4 weeks of being referred to us. Relevant data such as residual tumor location, number, stage, and grade were collected and analyzed. Patients with muscle invasive tumor or known incomplete resection were excluded.
  
  
  RESULTS
  Forty-seven patients met the inclusion criteria. Mean age was 75 years. In the initial TURBT, 35 (75%) had a high grade tumor and 12 (25%) had low grade tumors. Twenty-four (52%) were Ta and 23 (48%) were T1 tumors. Of the 47 patients who satisfied the criteria, 33 (70%) had an initial incomplete resection. Of these, 10 (30%) had macroscopic residual tumor at the resection site. Twenty-three (70%) had at least 1 unresected tumor away from the previous resection site. There were 39 unresected or partially resected tumors. Thirteen (33%) tumors were located in the anterior wall, 12 (31%) in the posterior wall and trigone, 10 (26%) in the lateral wall, 3 (7.5%) in the dome, and 1 (2.5%) in the prostatic urethra.
  
  
  CONCLUSIONS
  Although TURBT is a commonly performed operation, in this selected series, the incidence of unresected and gross residual tumor after initial TURBT is high. This indicates a need to emphasize the guidelines for a complete resection and to emphasize the use of a proper technique in this commonly performed urological procedure.
authors: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida 33101, USA.
authors: Kishore T
authors: KT
authors: Adiyat
authors: Devendar
authors: D
authors: Katkoori
authors: Cynthia T
authors: CT
authors: Soloway
authors: Rosely
authors: R
authors: De los Santos
authors: Murugesan
authors: M
authors: Manoharan
authors: Mark S
authors: MS
authors: Soloway
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D018365:Neoplasm, Residual; D012017:Referral and Consultation; D012189:Retrospective Studies; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*