UROLOGICAL ONCOLOGY

The value of a second transurethral resection in evaluating patients with bladder tumours
Miladi M, Peyromaure M, Zerbib M, Saighi D, Debre B
Department of Urology, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014
Paris, France
Eur Urol. 2003, 43:241-5

• Objectives: To evaluate the usefulness of a second transurethral resection for superficial and muscle-invasive bladder tumours.
• Methods: A review of the literature relevant to repeat resection for bladder tumours was conducted using Medline Services.
• Results: Transurethral resection of the bladder has two shortcomings: underestimating clinical stage, and overlooking other lesions. A second transurethral resection, when performed 2-6 weeks after the initial resection, corrects clinical staging errors in 9-49% of cases and detects residual tumor in 26-83% of cases. A second resection is particularly warranted for T1 tumours since 2-28% of them prove to be muscle-invasive, thus requiring a change in management. For muscle-invasive tumours, a second resection may be performed only if bladder sparing is being considered, as it helps to exclude the presence of tumor sites contra-indicating conservative treatment.
• Conclusions: A second transurethral bladder resection may be warranted for T1tumours, and for invasive tumours when a bladder preservation is planned.
  
• Editorial Comment
  The authors performed Medline-based review of the literature and which all papers on value of a second transurethral resection in superficial bladder tumours where evaluated. This is a timely and important paper as it condenses the known facts on the value of a second transurethral resection into one well-founded argument: Do it! At second TUR residual tumours are detected between 4 and 78% and, especially in T1-tumours range from a minimum of 33% to maximum of 78%. The stage of tumours is underestimated in 9-49% of tumours at first resection. The interval recommended in this paper is between 2 and 6 weeks, with no benefit in waiting more than 2 weeks. From our personal experience the interval of 1 week is also possible without an increase in complications. Morbidity is not increased significantly with the second TUR. In conclusion, this paper further underlines the importance of a second transurethral resection, especially in T1-tumours.

Dr. Andreas Böhle
Professor and Vice-Director of Urology
Medical University of Luebeck
Luebeck, Germany