Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer?

Schips, Luigi; Augustin, Herbert; Zigeuner, Richard; Gallé, G.; Habermann, Helga; Trummer, Harald; Pummer, Karl; Hubmer, G.

doi:10.1016/s0090-4295(01)01522-9

Cited by 130 publications

(65 citation statements)

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“…There is significant evidence in the literature to support re-TUR for high-risk non-muscle-invasive bladder cancer in order to limit rates of residual disease as well as the risk of under staging [8,[11][12][13][14][15][16]. Our study highlights a low level of re-resection in the management of non-muscleinvasive bladder cancer among some bladder cancer surgeons in Australia.…”

Section: Discussionmentioning

confidence: 82%

“…Under staging at the time of the initial transurethral resection is common for patients with high-risk NMIBC and can delay the accurate diagnosis and definitive treatment [5]. The rate of upstaging on the repeat transurethral resection from T1 to T2 disease ranges from 0 to 28% [6][7][8][9][10][11], but the rate of upstaging may be higher, up to 49% in one series, when muscularis propria is absent from the specimen [7]. Furthermore, the rates of residual disease or early recurrence ranges from 21 to 78% [6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…The rate of upstaging on the repeat transurethral resection from T1 to T2 disease ranges from 0 to 28% [6][7][8][9][10][11], but the rate of upstaging may be higher, up to 49% in one series, when muscularis propria is absent from the specimen [7]. Furthermore, the rates of residual disease or early recurrence ranges from 21 to 78% [6][7][8][9][10][11][12][13][14][15][16][17][18]. It is therefore recommended that in patients with high-risk disease and in those with large or multiple tumours or where the initial transurethral resection is incomplete, a repeat transurethral resection is performed within 2-6 weeks in order to guide appropriate management [19].…”

Section: Introductionmentioning

confidence: 99%

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Repeat transurethral resection for non‐muscle‐invasive bladder cancer: a contemporary series

et al. 2015

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ObjectivesTo evaluate the depth of transurethral resections of bladder tumour (TURBT), residual cancer rates and up-staging rates in a contemporary Australian series. Materials and MethodsSpecimen reports from a single, major reporting pathology centre, servicing a group of urological oncologists in Sydney were obtained for TURBTs performed between October 2008 and February 2013. We examined the depth of TURBT, rates of repeat-TURBT (re-TUR) and residual cancer rates at the 3-6 month check cystoscopy. ResultsOne thousand and two hundred and nine transurethral resection specimens retrieved during this period were analysed. There were 162 (13.4%) T1 specimens and 631 (52.2%) Ta specimens, 218 (34.5%) of which were high grade. Muscularis propria was present in 506 (41.9%) specimens in total and in 151 (39.7%) of 380 high-risk specimens (high grade Ta, T1). Of the 380 high-risk nonmuscle-invasive tumours, 85 (22.4%) proceeded to re-TUR. Of the 48 T1 specimens and 37 Ta high grade specimens that proceeded to re-TUR, 7 (14.6%) and 1 (2.7%) respectively were upstaged to muscle-invasive disease. Rates of residual disease/early recurrence at 3-6 months was significantly better for those with re-TUR compared to those without 56.8% vs 82.5% (P < 0.001) for Ta high grade and 39.6% vs 84% (P = 0.028) for T1 tumours respectively. ConclusionRe-TUR rates in high-risk non-muscle-invasive bladder cancer are low. However in a contemporary series, the upstaging rates are low, but residual cancer rates high, supporting the need for re-TUR in this population.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repeat transurethral resection for non‐muscle‐invasive bladder cancer: a contemporary series

et al. 2015

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“…Highgrade tumours lacking detrusor muscle in the initial resection specimen are subsequently associated with residual tumour or muscle invasive disease in up to 50% of cases. [42][43][44] Second TURBT…”

Section: Turbtmentioning

confidence: 99%

Update on the management of non-muscle invasive bladder cancer

Aldousari

Kassouf

2013

CUAJ

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Non-muscle invasive bladder cancer (NMIBC) is a heterogeneous population of tumours accounting for 80% of bladder cancers. Over the years, the management of this disease has been changing with improvements in results and outcomes. In this review, we focus on the latest updates on the management of NMIBC.Can Urol Assoc J 2010;4(1):56-64 RésuméLe cancer de la vessie sans envahissement musculaire est un groupe hétérogène de tumeurs représentant 80 % des cancers de la vessie. Au fil des années, la prise en charge de cette maladie a évolué, et les résultats et issues thérapeutiques se sont améliorés. Dans l'article qui suit, nous présentons les plus récents développe-ments dans la prise en charge de ce type de cancer.

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“…Klan et al (25) reported a residual tumour rate of 50% in patients with pT1 HG tumours; Herr (26) reported a rate of 74% residual tumours in 58 patients with pT1 HG bladder cancer, while Mersdorf et al (27) detected residual tumours in 58% (26 of 45 patients) pT1HG bladder cancer. WLre-cTURBT certainly detected a significant percentage of residual tumours and, among them, CIS and muscle invasive disease rates were reported with a range of 6% to 24% in different studies (28,29). Kitamura and Kakehi (30) suggested that optimal management strategies should be based on pathological find- …”

Section: Discussionmentioning

confidence: 98%

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

Giulianelli¹,

Gentile²,

Mirabile³

et al. 2017

Arch Ital Urol Androl

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Introduction: Understaging after initial transurethral resection is common in patients with high-risk non muscle infiltrating bladder cancer (NMIBC) and can delay accurate diagnosis and definitive treatment. The rate of upstaging from T1 to T2 disease after repeated transurethral resection ranges from 0 to 28%, although the rate of upstaging may be even higher up to 49% when muscularis propria is absent in the first specimen. A restaging classic transurethral resection of bladder tumour (re-cTURBT) is the better predictor of early stage progression. According to some reports, the rate of positivity for tumor in re-cTURBT performed within eight weeks after initial cTURBT was as high as 18-77%, and in about 40% of the patients a change in tumor stage was reported. We aimed to investigate, in high risk group, the presence of residual tumor following white light classical transurethral resection of bladder tumor (WLre-cTURBT) and the different recurrence and progression rate between patients with persistent or negative (pT0) oncological disease after WLre-cTURBT. Materials and methods: A cohort of 285 patients presenting with primitive bladder cancer underwent to WLcTURBT from January 2011 to December 2015; out of them 92 (32.28%) were T1HG. In according to EAU guidelines 2011, after 4-6 weeks all HG bladder cancer patients underwent a WL recTURBT . All patients were submitted to a subsequent followup including cystoscopy every 3 months with multiple biopsies, randomly and in the previous zone of resection; urinary citology on 3 specimens and kidney/bladder ultrasound every 6 months. The average follow-up was 48 months. Results: Following WLre-cTURBT we observed a persistent disease in 18 (15.2%) patients: 14 (77.7%) with a HG-NMIBC and 4 (22.2%) with a high grade (HG) muscle invasive bladder cancer (pT2HG). After follow up of all 92 patients according to the guidelines EAU, we observed recurrence in 36/92 (39.1%) and progression in 14/92 (15.2%). Of 14 NMIBC with persistent disease, 10 patients (71.4%) showed recurrence: 4 patients (40%) were pT1HG with concomitant carcinoma in situ (CIS), 3 patients (30%) multifocal pTaHG, 2 (20%) patients CIS and one patient (10%) a muscle invasive neoplasm (pT2HG). Instead of the group of 48 patients pT0 following WL recTURBT, we observed recurrence in 26 patients (54.1%) and in two patients (4.1%) progressions, who presented after 3 months in association with CIS. The remaining 22 patients (45.9%) with initial pT1HG are still progression free. Multivariate analysis showed that the most important variable of early progression were persistent neoplasm and histopathological findings at WLre-cTURBt (p = 0.01), followed by the Summary No conflict of interest declared. INTRODUCTION Bladder cancer is a common genito-urinary malignancy, with transitional cell carcinoma comprising nearly 90% of all primary bladder tumours. At the first diagnosis 70% to 80% of urothelial tumours are confined to the epithelium, the remainder is characterized by muscle invasion. A significant number of patients with high risk non-muscle invasive bladder tumours (HG-NMIBT) treated with white light classic transurethral resection of bladder tumours (WLcTURBT) and intravesical BCG will progress to invasive disease (1-3). Progression to muscle invasion (pT2) mandates immediate radical cystectomy (4). WLcTURBT is the standard initial therapy for NMIBT, but the high percentage of recurrence after surgery is still an unresolved problem (5). High grade pT1 bladder neoplasm (pT1HG) really represents a therapeutic challenge due to the high risk of progression (about 15-30%) to muscle-invasive disease, usually within 5 years (6). However, no consensus exists regarding the treatment of patients with recurrent bladder tumours that invade the lamina propria (pT1) (7-9). Recent studies suggested that the first cTURBT may be incomplete in a significant number of cases (10). Understaging at the time of the initial transurethral resection is common for patients with high-risk NMIBC and can delay accurate diagnosis and definitive treatment. It is therefore recommended for patients with high-risk disease and in those with large or multiple tumors or when the initial transurethral resection is incomplete, to repeat WLre-cTURBT within 2-6 DOI: 10.4081/aiua.2017.4.272 result of the first cystoscopy (p = 0.002) and presence of CIS (p = 0.02). Discussion: Following WLre-cTURBt in HG-NMIBC patients we identified in 15% of cases a persistent disease with a 4.3% of MIBC. In the high risk persistent bladder neoplasms group we observed recurrent and progression rate higher than in T0 bladder tumours group (Δ = + 17.3% and = Δ + 62.5%, p < 0.05

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Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer?

Cited by 130 publications

References 2 publications

Repeat transurethral resection for non‐muscle‐invasive bladder cancer: a contemporary series

Repeat transurethral resection for non‐muscle‐invasive bladder cancer: a contemporary series

Update on the management of non-muscle invasive bladder cancer

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

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