Impact of Repeat Transurethral Resection of Muscle-Invasive Bladder Cancer - Expert Commentary

Transurethral resection of bladder tumor (TURBT) is therapeutic in non-muscle invasive bladder cancer (NMIBC), but the role of repeat TURBT (reTURBT) in MIBC patients remains poorly understood. TURBT with concurrent radiotherapy and chemotherapy can contribute to bladder preservation. It has also been shown to improve patient outcomes when performed before the administration of neoadjuvant chemotherapy, although some findings have been contradictory. Bree et al., therefore, sought to identify the effects of reTURBT before radical cystectomy in MIBC patients.

The study cohort consisted of 657 patients with cT2N0 MIBC who underwent radical cystectomy. The median follow-up duration was 64.9 months, and 58% of patients underwent reTURBT. The median age was 69, and 83% of patients were male. With respect to treatment, 45% of patients received neoadjuvant chemotherapy. At radical cystectomy, 55% of patients had muscle-invasive disease, and 21% had pathological nodal involvement. Patients who received chemotherapy were more likely to undergo reTURBT, while older age and absence of lymphovascular invasion were associated with a decreased likelihood of reTURBT. In 39 to 59% of patients who underwent reTURBT, a lower or concordant pathological stage was observed at reTURBT relative to radical cystectomy. On the other hand, more than 60% of patients who were pT0 at reTURBT had residual disease at radical cystectomy, and 18% of patients had extravesical disease.

Overall survival was comparable between patients who underwent reTURBT and those who did not (control). Median overall survival was 82.9 months in the reTURBT group and 74.9 months in the control group (P=0.7). While relapse-free survival was also similar between groups, median relapse-free survival was not reached in the reTURBT group, while it was 155.7 months in the control group. Higher overall survival and relapse-free survival was observed in patients with pT0 and no residual disease on reTURBT. In patients who underwent reTURBT without chemotherapy (198 patients), no residual disease at reTURBT was associated with higher overall survival and relapse-free survival rates. In patients who underwent reTURBT and received neoadjuvant chemotherapy (181 patients), <pT2 status was associated with better survival incomes.

This study indicates that repeat TURBT prior to radical cystectomy is not associated with enhanced survival among MIBC patients. The absence of residual tumor on pathological evaluation of reTURBT was prognostic and was associated with improved survival outcomes. As a result of the retrospective study design, important data regarding the timing of reTURBT and neoadjuvant chemotherapy were missing, in addition to the percentage of visible residual tumors after reTURBT.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine


  1. Bree KK, Kokorovic A, Westerman ME, et al. Repeat Transurethral Resection of Muscle-invasive Bladder Cancer Prior to Radical Cystectomy is Prognostic but Not Therapeutic. J Urol. 2023;209(1):140-149. doi:10.1097/JU.0000000000003015
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