Evaluation of Second-Look Transurethral Resection in Restaging of Patients with Nonmuscle-Invasive Bladder Cancer

Abstract

PURPOSE: Evaluation of second-look transurethral resection (TUR) in avoidance of staging errors, and determination of risk factors of upstaging in patients with nonmuscle invasive bladder cancer. PATIENTS AND METHODS: An analytic prospective cohort study included 91 patients with stage T(1) and T(a) bladder cancer. All patients underwent second-look TUR within 2 to 6 weeks after the initial resection. Histopathologic findings of the second TUR of bladder tumor (TURBT) were compared with those of the initial one. RESULTS: Specimens obtained during the second TURBT showed no tumor in 38 (41.7%) patients; 22 (24.2%) patients had residual cancer of the same stage, 9 (14.8%) patients of PT(1) had a lower stage, and 22 (24.2%) had a higher stage. Upstaging had changed treatment strategy in 22 (24.2%) cases. Appearance, size, grade, and stage of the tumor at the initial resection are all considered independent risk factors for upstaging detected at second-look TURBT. CONCLUSIONS: Second TURBT is a valuable procedure for accurate staging of nonmuscle-invasive bladder cancer. It changed the treatment strategy of a significant proportion of our patients. Second TURBT is indicated in T(1), high grade, large size (>3 cm), and nodular tumors because of the significant risk of detecting muscle-invasive disease.