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Purpose: To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy., Materials and Methods: This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability. We used multivariable logistic regression models to assess whether EUA performed by blinded or non-blinded examiners is associated with soft tissue positive surgical margins (PSMs) and to calculate the fraction of new information added by such an examination in addition to selected clinical variables., Results: Among the 134 patients analyzed, limited bladder mobility was indicated by the blinded and non-blinded examiners in 23 (17.2%) and 21 (15.7%) cases, respectively. PSMs were identified in 22 (16.4%) patients, more often in patients with limited bladder mobility as assessed by the blinded (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.9-24.2) and non-blinded examiners (OR 12.9; 95% CI, 2.9-57.5). The fraction of new information added by the blinded and non-blinded examiners was 48.6% and 57.7%, respectively. The enrichment of patients who underwent pure laparoscopic cystectomy (n = 102; 76%) and the inclusion of patients for emergent surgery may limit the generalizability of our findings., Conclusions: The identification of limited bladder mobility during preoperative EUA yielded prognostic information on surgical margin status. Our findings suggest that EUA has the potential to provide valuable insights in the assessment of bladder resectability. However, further research in a larger cohort of patients is warranted to validate and expand on these findings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To prospectively assess the concordance of examination under anesthesia (EUA)-based clinical T stage with pathological T stage and diagnostic accuracy of EUA in patients with bladder cancer undergoing cystectomy., Methods: Consecutive patients with bladder cancer undergoing cystectomy between June 2017 and October 2020 in a single academic center were included in a prospective study. Two urologists performed EUA (one blinded to imaging) before patients underwent cystectomy. We assessed the concordance between clinical T stage in bimanual palpation (index test) and pathological T stage in cystectomy specimens (reference test). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CIs) to detect or exclude locally advanced bladder cancer (pT3b-T4b) in EUA., Results: The data of 134 patients were analyzed. Given that stage pT3a cannot be palpated, for the nonblinded examiner, T staging in EUA was concordant with pT in 107 (79.9%) patients, 20 (14.9%) cases being understaged in EUA and 7 (5.2%) overstaged. For the blinded examiner, staging was correct in 106 (79.1%) patients, 20 (14.9%) cases being understaged and 8 (6%) overstaged. For the nonblinded examiner, sensitivity, specificity, PPV, and NPV of EUA were 55.9% (95% CI 39.2%-72.6%), 93% (88%-98%), 73.1% (56%-90.1%), and 86.1% (79.6%-92.6%), respectively; for the blinded examiner, they were 52.9% (36.2%-69.7%), 93% (88%-98%), 72% (54.4%-89.6%) and 85.3% (78.7%-92%), respectively. Awareness of imaging results did not have a major impact on EUA results., Conclusion: Bimanual palpation should still be used for clinical staging, given its specificity, NPV, and that it could correctly determine bladder cancer T stage in 80% of cases., Competing Interests: Declaration of Competing Interest None to declare, (Copyright © 2023 Elsevier Inc. All rights reserved.)