Clinical rationale and safety of restaging transurethral resection in indication-stratified patients with high-risk non-muscle-invasive bladder cancer

Abstract

BackgroundIndications for restaging transurethral resection of the bladder tumor (reTURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) remain controversial. This study was aimed at evaluation of clinical value and safety of reTURBT in different clinical indications.MethodsThis is a retrospective analysis of consecutive 141 patients who underwent TURBT followed by reTURBT in years 2011–2015 in a single department. Pathological results and surgical complications were analyzed in the whole study cohort and stratified by clinical stage (Ta, T1, Tx (no muscle in the specimen)) and grade (low-grade (LG), high-grade (HG)) of bladder cancer diagnosed at primary TURBT.ResultsFull data was available for 132 patients. Residual disease was found in 53 patients (40.2%) with highest rate for Ta-HG cases (57.1%) followed by T1-HG (51.4%), Tx-HG (45.2%), T1-LG (32.1%), and Tx-LG (25.8%). In the multivariate analysis, high grade (p = 0.02) was the only independent predictor of residual disease. Upstaging to muscle-invasive bladder cancer was noticed in 9 patients (6.8%). The rate of grade ≥ 2 Clavien-Dindo complications (1.5 vs. 5.3%) did not differ significantly between TURBT and reTURBT cases.ConclusionsReTURBT is a safe procedure that remains crucial for therapeutic and staging purposes in patients with T1, Tx, or high-grade bladder cancer found in the primary resection.

Impact of the COVID-19 Pandemic on the Urologist’s clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period

“…Repeat TURBT is the standard of care for non-muscle-invasive high-risk bladder tumors (34). However, during the pandemic, some exceptions can be considered.…”

The TaHG bladder cancer – the devil is as black as he is painted

“…Recently, we have independently addressed similar questions in patients from Central Europe [3, 4]. In our studies, the residual tumour was found in 36–40% of cases at reTURBT, with the highest rate in TaHG cases (57%).…”

Transurethral needle electrode resection and transurethral holmium laser resection of bladder cancer

“…Strong obturator nerve reflex can cause complications such as bladder perforation. If the tumor location is unique, risks such as ureteral orifice stricture, urethral stricture, tumor residue, and disseminated implantation may occur after TURBT, as well as disadvantages such as easy burning of tumor specimens to form eschar and difficulty in accurate pathological staging [ 24 – 27 ].…”