SIU 2017: Second Look Transurethral Resection of Bladder Tumor: Is It Necessary in All T1 and/or High Grade Tumors?

Lisbon, Portugal (UroToday.com) Repeat TURBT after an initial diagnosis of NMIBC, specifically high-grade T1 disease, is recommended by most guidelines. Due to moderate ~20-30% rate of understaging on initial TURBT, repeat TURBT is recommended to ensure that MIBC is not missed. However, considering the potential cost implications, patient discomfort, and potential risks of repeat TURBT, there has been renewed interest to reassess the need of repeat TURBT.

This group from Iran provide their small single-institution experience with repeat TURBT. They examined 107 patients with either T1 or any high-grade urothelial carcinoma on TURBT – there is no comment on whether this was retrospective/prospective, initial diagnosis, etc. Repeat TURBT was completed within 6 weeks. 

They identified upstaging – not defined in the abstract – in 11 patients (10.3%) and residual tumor of the same grade/stage in 18 patients (16.8%). Tumor size, multifocality, and presence of muscle at resection were all associated with upstaging/upgrading – however, they don’t document whether the were associated with more or less upstaging/upgrading. 

Among 48 patients with single, small (<3 cm) tumors who underwent adequate resection initially (muscle in specimen), neither upstaging or upgrading was noted. They suggest that this subset, there may be a role to avoid repeat TURBT. 

However, this single institution small series makes it quite difficult to make any significant conclusions. There are trials that approaching this question prospectively. 

Presented by: Mohsen Ayati 

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd, at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal
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