Bimanual palpation for staging of bladder cancer-clinical use and its predictors

Objective: To analyze the frequency of performing bimanual palpation (BP) during transurethral resection of the bladder tumor (TURBT) and to identify its predictors. Material and methods: This retrospective analysis enrolled 568 consecutive patients, who underwent TURBT due to primary bladder cancer. There were thirty surgeons involved in the analysis, each performed a mean of 18.9 TURBTs (range 1-43). Univariate and multivariate logistic regression analyses were performed to identify factors predicting the BP use. Results: Two hundred and sixty-five patients (46.7%) underwent BP. BP was performed in 36.1% of Ta tumors, 49.1% of T1 tumors and 76.6% of >= T2 tumors (p<0.001); in 60.2% of tumors >3 cm and in 33.3% of tumors <3 cm (p<0.001). Female, and male doctors performed BP in 38.3%, and 48.8% of the cases, respectively (p=0.01). Senior residents performed BP more often than junior residents and certified junior and senior urologists (64.6% vs. 39.2% vs. 48.2% vs. 31.1%, respectively; p=0.03). In multivariate logistic regression analysis higher tumor stage, larger tumor size, as well as senior residents and male surgeons performing TURBT were independent predictors of BP. Conclusion: Though BP is recommended for each patient at the time of TURBT, it is performed only in the minority of patients undergoing TURBT, mainly those with advanced or larger tumors, operated by senior residents and male surgeons.