Does Repeating of Transurethral Resection of Bladder Tumors Change Treatment Plan for All T1 Tumors?

A main problem in the proper management of non–muscle invasive bladder cancer (NMIBC) is the under staging of lesions after initial transurethral resection of bladder tumor (TUBRT). Under staging is much more likely in T1 tumors when the detrusor muscle is absent. So, we evaluated under-staging and residual tumor in patients with complete initial TURBT, whose initial pathological samples revealed the presence of the detrusor muscle.

In this prospective study performed in our hospital from August 2018 to April 2020, 51 patients with newly diagnosed T1 bladder tumor were enrolled according to our criteria and underwent standard Re-TURBT before eight weeks after the initial TURBT.

Of the 51 patients who underwent Re-TURBT, 12 patients (23.5%) had tumors, of whom eight patients had microscopic, and four patients had macroscopic tumors. None of them were upstaged or upgraded. There was a statistically significant relationship between the presence of tumor in Re-TURBT and the size of the primary tumor (> 3 cm) and the number of tumors (> 1). Not only no changes were observed in the stage and grade of the disease, but also the treatment plan of the patients did not change despite imposing financial burden on the patient and the health system.

Re-TURBT is not necessary for all superficial bladder tumors, especially in the case of complete initial TURBT and also in the presence of the detrusor muscle in the pathological sample, and when the tumor is single and less than three centimeters in size.