Outpatient Transurethral Resections of Bladder Tumours: Insights from the Largest Cohort to Date.

Abstract

Objectives: Outpatient transurethral resection of bladder tumours (TURBT) is not widespread, involving only 5% of patients. Our aim was to assess the feasibility of TURBT in an outpatient setting and to evaluate factors possibly associated with conversion to inpatient care as well as unscheduled care.

Subjects and methods: All consecutive outpatient TURBT performed between January 2016 and December 2022 in one academic center were retrospectively analyzed. Outpatient success was defined as the absence of conversion to conventional hospitalization (CH) as well as the absence of unscheduled care within 30 postoperative days. The quality of the resection was assessed by the presence of detrusor muscle in the surgical specimen.

Results: A total of 500 consecutive outpatient TURBT were included in 376 patients. Outpatient-TURBT was performed for primary tumour diagnosis in 187 (37%) cases, second look in 66 (13%) cases and tumour relapse in 216 (43%) cases. Muscle was present in 86% of cases. Perioperative inpatient conversions occurred in 40 cases (8%). Once converted, patients stayed a median of 2 days IQR[1;3]. Seventy-seven post-TURBT unscheduled care were observed (15%) with 40 emergency room visits (8%) and/or 22 rehospitalizations (4%), occurring on a median post-operative day 3 IQR[1 ; 4]. Overall complication rate was 11% (51 cases of grade 1 and 2 complications (10%) and 6 cases of grade 3 complications (1%)). Multivariate predictors of outpatient-TURBT failure were specimen weight ≥1g (OR=4.35, 95%CI: 1.60 - 13.3, p=0.007), surgery duration (OR=1.03, 95%CI: 1.06 - 1.71), p=0.002) and antiplatelet treatment (OR=2.86, 95%CI: 0.864 - 9.17, p=0.077) Conclusion : Outpatient TURBT appears to be acceptable with an 8% conversion rate, as well as safe, with an 11% complication rate. Quality of the resection was not affected by the outpatient setting. Tumour weight ≥1g, surgery duration and absence of antiplatelet treatment were significant multivariate predictors of outpatient surgery failure.