Impact of audit and feedback on transurethral resection of bladder tumour quality: a monocentric post-completion evaluation of the RESECT trial

Objective: To assess whether improvements in transurethral resection of bladder tumour (TURBT) quality achieved during the RESECT international study (ClinicalTrials.gov identifier: NCT05154084) were sustained over time following completion of the programme at our institution and to investigate their effect on disease recurrence. Patients and Methods: We conducted a prospective, observational monocentric cohort study at a tertiary university hospital. A total of 128 consecutive patients undergoing TURBT between March 2023 and June 2025 and meeting RESECT eligibility criteria were analysed. Four pre-defined surgical quality indicators—detrusor muscle sampling, completeness of resection, accuracy of operative documentation, and administration of single immediate intravesical chemotherapy (SI-IVC)—were compared across three institutional phases: pre-audit, prospective audit and post-audit RESECT periods. Recurrence-free survival (RFS) at follow-up was evaluated by cystoscopy and histological confirmation with TURBT. Results: Detrusor muscle presence improved from 61.9% in the pre-audit phase to 70.7% during the prospective audit and 85.9% post-audit (P < 0.001). Completeness of resection documentation increased from 88.4% to 96.3% and 97.6%, respectively (P < 0.001), while documentation accuracy remained high across all phases (93.2%, 96.3%, and 96.1%). SI-IVC use rose from 0% in the first two phases to 25% after audit closure. Despite these improvements, RFS did not differ significantly between phases. Conclusion: Participation in a service-wide audit and feedback programme resulted in sustained improvements in TURBT surgical quality indicators after programme completion. This did not yield a detectable reduction in recurrence, highlighting the multifactorial nature of oncological outcomes in non-muscle-invasive bladder cancer. Further studies are required to identify which quality metrics most strongly influence long-term prognosis