As all urologists treating non–muscle-invasive bladder cancer know, repeated transurethral resection of the bladder (re-TURB) carries significant risks, including general anesthesia, prolonged bladder catheterization, bleeding, and even acute urinary retention. Our goal, therefore, is to minimize the number of such procedures while still limiting recurrence, preventing tumor progression, and ensuring accurate staging.
In this context, patients with pTa low-grade (pTaLG) tumors and no detrusor muscle present in the initial resection specimen should not undergo a second resection, as the likelihood of muscle invasion is low when the lamina propria is tumor-free —an approach supported by both European and American guidelines.
However, we questioned the rationale for routinely performing re-TURB in patients with pTa high-grade (pTaHG) tumors solely to confirm the presence of detrusor muscle, even if the superficial layers are uninvolved. This is particularly relevant given that re-TURB has not been shown to improve oncological outcomes in this subgroup.
In our real-life multicenter study including 418 patients, the absence of detrusor muscle in the initial resection specimen was not associated with increased risk of recurrence or progression after five years of follow-up. Moreover, in patients without detrusor muscle in the initial specimen, undergoing a second resection did not improve progression-free survival. This result further challenges the relevance of recommending re-TURB in pTaHG cases, even when the detrusor muscle is absent in the initial resection.
Written by: Gabrielle Tissot, Department of Urology, Assistance Publique-Hôpitaux de Paris Nord, Bichat Claude-Bernard Hospital, University Paris Cité, Paris, France.
References:
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