title: [Impact of operator experience on TURB of high-grade non-muscle-invasive bladder cancer--analysis of 254 second resections at a university teaching hospital].
abstract: BACKGROUND
  In departments with urological training of residents, part of the TURB procedures are performed as "teaching surgery". Does resection quality and early recurrence depend on the operator's experience?
  
  
  METHODS
  From July 2007 to February 2012 254 second resections (TURB) after Ta high-grade and T1 high-grade bladder tumours were performed at our institution. The surgeons were stratified into "junior residents" (first and second year of training), "experienced residents" (3rd-5th year of training), board certified urologists, consultants and chief surgeons. We analysed the risk of recurrence at second resection and characteristics of the initial TURB.
  
  
  RESULTS
  87 patients presented with a Ta high-grade tumour (34.3%) and 167 had a T1 high-grade lesion (67.7%). Most TURBs were performed by "experienced residents" (3rd-5th year) and the chief of department. The recurrence rate at second resection was 52.4%. A significant association with the recurrence rate was shown for the number of initial tumours, size and T-stage. No association was found for the training level of the surgeon. Additionally, there was no different detrusor rate for the surgeons, as a parameter for a correct, muscle-deep TURB. A bias that surgeons in training had more favourable tumours (solitary, less than 3 cm) could be excluded.
  
  
  CONCLUSIONS
  In our data detrusor rate and recurrence risk at second resection are independent of the surgeon's experience. The results of "teaching-TURBs" are not inferior compared to TURBs performed by board certified urologists or consultants under the conditions of undisturbed communication and personal supervision.
authors.affiliation: Klinik für Urologie und Kinderurologie, HELIOS Klinikum Wuppertal, Zentrum für Forschung in der klinischen Medizin (ZFKM), Universität Witten/ Herdecke, Wuppertal, Germany. david.lazica@helios-kliniken.de
authors.forename: D A
authors.initials: DA
authors.lastname: Lazica
authors.forename: S
authors.initials: S
authors.lastname: Degener
authors.forename: S
authors.initials: S
authors.lastname: Böttcher
authors.forename: A S
authors.initials: AS
authors.lastname: Brandt
authors.forename: S
authors.initials: S
authors.lastname: Störkel
authors.forename: S
authors.initials: S
authors.lastname: Roth
mesh_terms: D002983:Clinical Competence; D003558:Cystoscopy / Q000193:education*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010823:Physician Assistants / Q000193:education; D008486:Physician Executives / Q000193:education; D011786:Quality Control; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D014572:Urology / Q000193:education*