Abstract
Background: Bladder cancer is a prevalent malignancy of the urinary system, with superficial tumors representing the majority of cases. Despite initial treatment with transurethral resection (TUR), these tumors have high recurrence rates (70-80%) and can progress to muscle-invasive disease in 20-30% of cases. Repeat transurethral resection (re-TUR) has been proposed as a method to improve staging accuracy and reduce the likelihood of recurrence by detecting residual tumor tissue.
Methods: This prospective study included 100 patients with superficial bladder cancer (Ta and T1 stages) treated at the Urology Clinic of Istanbul Fatih Sultan Mehmet Training and Research Hospital between January 2005 and December 2006. Following the initial TUR, all patients underwent re-TUR within 4 to 6 weeks. Pathological findings from both procedures were analyzed to identify residual tumor presence and changes in tumor stage. Patients were followed up for 24 months to monitor recurrence rates and progression to muscle-invasive disease.
Results: Re-TUR revealed residual tumor tissue in 40% of patients, with higher detection rates in T1 and Grade II tumors. Patients with residual tumors had a significantly higher recurrence rate (40%) compared to those without residual tumors (15%). Additionally, 20% of patients with residual tumors progressed to muscle-invasive bladder cancer, while no progression was observed in patients without residual tumors.
Conclusion: Re-TUR plays a vital role in improving staging accuracy and reducing recurrence in patients with superficial bladder cancer. The presence of residual tumors significantly increases the risk of recurrence and progression, highlighting the importance of re-TUR, especially in high-risk patients. These findings support the routine use of re-TUR in managing superficial bladder cancer.
References
- 1. Edward M. Messing, MD, Urothelial tumors of the urinary tract In Campbell’s Urology, Eight Edition, 4th volume W.B. Saunders, USA 2002: pp 2723-2784.
- 2. Herr, HW: Uncertainty and outcome of invasive bladder tumors. Urol Oncol 1996;2:92.
- 3. Herr H: The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol 1999;162: 74–76.
- 4. Vögeli TA, Grimm MO, and Ackermann R: Prospective study for quality control of TUR of bladder tumors by routine 2nd TUR. J Urol 1998;159(suppl):143.
- 5. Klän R, Loy V, and Huland H: Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol 1991;146:316–318.
- 6. Herring JC, Kamat AM. Treatment of muscle-invasive bladder cancer: progress and new challenges. Expert Rev Anticancer Ther. 2004;4(6):1047-1056. doi:10.1586/14737140.4.6.1047.
- 7. Köhrmann KU, Woeste M, Rassweiler J, et al: Die transurethrale Nachresektion, notwendig beim oberflächlichen Blasenkarzinom. Urologe A 1992;31(suppl):A59.
- 8. Brausi M, Collette L, Kurth K, van dermatoz Meijden AP, Oosterlinck W, Witjes JA, et al. Variability in the recurrence rate at first follow up cystoscopy afterTUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol 2002;41:523-31.
- 9. Dutta SC, Shappell SB, Smith JA, Cookson MS. Radical cystectomy in high-risk non-muscle invasive transitional cell carcinoma: indications and outcomes. J Urol 2000;163(Suppl):149.
- 10. Miladi M, Peromaure M, Zerbib M, Saighi D, Debre B. The value of a second transurethral resection in evaluating patients with bladder tumours. Eur Urol 2003;43:241-245.
- 11. Filbeck T, Roessler W, Knuechel R, Straub M, Kiel HJ, Wieland WF. 5- aminolevulinic acid-induced fluorescence endoscupy applied at secondary transurethral resection after conventional resection of primary superficial bladder tumors. Urology 1999;53:77-81.
- 12. Klan R, Loy V, Huland H. Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol 1991;146:316-8.
- 13. Brauers A, Buettner R, Jakse G. Second resection and prognosis of primary high risk superficial bladder cancer: is cystectomy often too early? J Urol 2001;165:808-10.
- 14. Thompson RA Jr, Campbell EW, Kramer HC, Jacobs SC, Naslund MJ. Late invasive recurrence despite long-term surveillance for superficial bladder cancer. J Urol 1993; 149:10-14.
Abstract
References
- 1. Edward M. Messing, MD, Urothelial tumors of the urinary tract In Campbell’s Urology, Eight Edition, 4th volume W.B. Saunders, USA 2002: pp 2723-2784.
- 2. Herr, HW: Uncertainty and outcome of invasive bladder tumors. Urol Oncol 1996;2:92.
- 3. Herr H: The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol 1999;162: 74–76.
- 4. Vögeli TA, Grimm MO, and Ackermann R: Prospective study for quality control of TUR of bladder tumors by routine 2nd TUR. J Urol 1998;159(suppl):143.
- 5. Klän R, Loy V, and Huland H: Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol 1991;146:316–318.
- 6. Herring JC, Kamat AM. Treatment of muscle-invasive bladder cancer: progress and new challenges. Expert Rev Anticancer Ther. 2004;4(6):1047-1056. doi:10.1586/14737140.4.6.1047.
- 7. Köhrmann KU, Woeste M, Rassweiler J, et al: Die transurethrale Nachresektion, notwendig beim oberflächlichen Blasenkarzinom. Urologe A 1992;31(suppl):A59.
- 8. Brausi M, Collette L, Kurth K, van dermatoz Meijden AP, Oosterlinck W, Witjes JA, et al. Variability in the recurrence rate at first follow up cystoscopy afterTUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol 2002;41:523-31.
- 9. Dutta SC, Shappell SB, Smith JA, Cookson MS. Radical cystectomy in high-risk non-muscle invasive transitional cell carcinoma: indications and outcomes. J Urol 2000;163(Suppl):149.
- 10. Miladi M, Peromaure M, Zerbib M, Saighi D, Debre B. The value of a second transurethral resection in evaluating patients with bladder tumours. Eur Urol 2003;43:241-245.
- 11. Filbeck T, Roessler W, Knuechel R, Straub M, Kiel HJ, Wieland WF. 5- aminolevulinic acid-induced fluorescence endoscupy applied at secondary transurethral resection after conventional resection of primary superficial bladder tumors. Urology 1999;53:77-81.
- 12. Klan R, Loy V, Huland H. Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol 1991;146:316-8.
- 13. Brauers A, Buettner R, Jakse G. Second resection and prognosis of primary high risk superficial bladder cancer: is cystectomy often too early? J Urol 2001;165:808-10.
- 14. Thompson RA Jr, Campbell EW, Kramer HC, Jacobs SC, Naslund MJ. Late invasive recurrence despite long-term surveillance for superficial bladder cancer. J Urol 1993; 149:10-14.
Details
| Primary Language | English |
|---|---|
| Subjects | Urology |
| Journal Section | Clinical Research |
| Authors | |
| Early Pub Date | December 12, 2024 |
| Publication Date | January 1, 2025 |
| Submission Date | October 17, 2024 |
| Acceptance Date | October 21, 2024 |
| Published in Issue | Year 2025Volume: 16 Issue: 1 |
