Primary Complete Transurethral Resection of Bladder Tumor using Photodynamic Diagnosis for High-risk Non-Muscle Invasive Bladder Cancer: Is a Restaging Photodynamic Transurethral Resection Really Necessary?

To evaluate the risk of residual tumor and tumor upstaging during a second resection after primary complete Transurethral Resection of Bladder Tumor (TURBT) using Photodynamic Diagnosis (PDD) for high-risk Non-Muscle Invasive Bladder Cancer (NMIBC).

From January 2014 to March 2020, a single-institutional study was conducted including consecutive patients with high-risk NMIBC (T1 and/or cis and/or high grade) who underwent a restaging transurethral resection (reTUR) within 12 weeks following a primary complete resection. Each TURBT was performed using blue light after intravesical instillation of Hexaminolevulinate. The primary endpoint was detection of residual tumor at reTUR, proved with positive pathology report.

A total of 109 consecutive patients with high-risk NMIBC underwent reTUR after a primary complete blue light resection. Pathological evaluation of the surgical specimens of the primary TURBT revealed stage T1 and high-grade tumors in 69 (68.3%) and 108 (99%) patients, respectively, and concomitant CIS was found in 45 patients (41.3%). The median time to reTUR was 8 (6-10) weeks. Residual tumor was detected histopathologically in 64 of 109 patients (58.7%) at the second TURBT with PDD. In five of these patients (4.5%), initial T1 tumors were upstaged to T2 tumors.

We examined a contemporary series of patients undergoing reTUR with PDD as management of high-risk NMIBC proven at the first blue light resection. We reported a 54.2% risk of disease persistence and a 4.5% risk of understaging in T1 tumors. These findings support that reTUR is still necessary after initial complete TURBT with PDD. Further studies are needed to assess the long-term oncologic outcomes of reTUR with PDD.

Journal of endourology. 2021 Feb 25 [Epub ahead of print]

Abel Tadrist, Bastien Gondran-Tellier, Robin McManus, Khalid Al-Balushi, Akram Akiki, Sarah Gaillet, Veronique Delaporte, Gilles Karsenty, Eric Lechavallier, Romain Boissier, Michael Baboudjian

Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Marseille, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Marseille, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Conception Academic Hospital, Aix Marseille University, Marseille, Marseille, France, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, hopital la conception, Marseille, France, 13005; ., Aix-Marseille Université, APHM, La Conception Academic Hospital, Department of Urology and Renal Transplantation, 13005, France; ., Aix-Marseille Université, APHM, La Conception Academic Hospital, Department of Urology and Renal Transplantation, Marseille, France., Paris, France; ., Assistance Publique Hopitaux de Marseille, 36900, Urologie, Marseille, Provence-Alpes-Côte d'Azu, France; ., hopital La Conception, Urologie, 147 bd Baille, Marseille, France, 13385; ., Aix-Marseille-University, 128791, Urology and kidney transplantation, Marseille, Provence-Alpes-Côte d'Azu, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, 147 bd baille, Marseille, France, 13005.