UROLOGICAL ONCOLOGY

Is A Second Transurethral Resection Necessary For Newly Diagnosed Pt1 Bladder Cancer?
Divrik T, Yildirim U, Eroglu AS, Zorlu F, Ozen H
Department of Urology, SSK Tepecik Teaching Hospital, Izmir, Turkey
J Urol. 2006; 175: 1258-61

• Purpose: We evaluated the potential benefit of a second transurethral resection in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder.
• Materials and Methods: Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol in which all patients prospectively received second TUR within 2 to 6 weeks following the initial resection. Patients with incomplete resections were excluded from study. The pathological findings of the second TUR were reviewed.
• Results: Of the 80 patients who underwent second resection, 18 (22.5%) had macroscopic tumors before resection. However, with the addition of microscopic tumors, overall residual disease was determined in 27 (33.8%) patients. Of the 27 patients 7 had pTa, 14 had pT1, 3 had pT1+pTis and 3 had pT2 disease. Residual cancers were detected in 5.8%, 38.2% and 62.5% in G1, G2 and G3 tumors, respectively. The risk of residual tumor directly correlated with the grade of the initial tumor (p = 0.009).
• Conclusions: Although second TUR dramatically changed the treatment strategy in a small percentage of cases, we strongly recommend performing second TUR in all cases of primary pT1 disease, especially in high-grade cases.
  
  
• Editorial Comment
  This paper highlights the usefulness of a second transurethral resection in superficial bladder cancer by providing own data and a review of the meanwhile large body of literature evidence.
  In their own data the authors found at least 18.8% residual tumor at second TUR with an increasing rate up to 33.8% in large and/or multifocal tumors. In the literature, up to 74% of T1G1-3 tumors had residual disease. A second TUR is highly recommended at least in large tumors and all T1 tumors.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany