Vol. 9, Issue 2, Part C (2025)

Introduction: A high-quality transurethral resection of bladder tumor (TUR-BT) is essential for accurate staging and appropriate management of bladder cancer. The presence of detrusor muscle (DM) in the resected specimen is a recognized quality indicator. Absence of DM may result in understaging, increased recurrence, and suboptimal oncological outcomes. This study aimed to identify patient-, surgical-, and tumor-specific factors associated with the absence of DM in TUR-BT specimens.
Methods: This prospective study was conducted at INU, Bengaluru, from February 2023 to February 2024, involving 100 patients undergoing TUR-BT. Inclusion criteria were age >18 years and presence of visible bladder tumor on cystoscopy. Patients with suspected carcinoma in situ, incomplete histopathological data, or who were lost to follow-up were excluded. The presence of DM was confirmed through pathological evaluation. Variables assessed included age, sex, BMI, tumor size, configuration, multiplicity, location, operative time, and use of obturator nerve block. Statistical analysis was performed using chi-square and Mann-Whitney U tests, with a significance threshold of p<0.01.
Results: DM was present in 60% and absent in 40% of specimens. DM presence was more likely in patients with tumor size <3 cm (58%), single (66%), and solid tumors (66%). Tumors located on the lateral (87.5%) and posterior walls (80%) were associated with higher DM inclusion compared to roof tumors (22%). Obturator block was performed in 75% of patients with DM present. Longer operative time (average 45 minutes) was also associated with DM retrieval.
Conclusion: Tumor configuration, location, operative duration, and surgical techniques such as obturator block significantly influence DM inclusion. Recognizing high-risk constellations for missing DM can help improve TUR-BT quality through targeted training, case allocation, and increased surgeon awareness-ultimately enhancing patient outcomes.