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UROSCAN |
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| Year : 2006 | Volume
: 22
| Issue : 2 | Page : 166-167 |
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Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer?
Aneesh Srivastav, Rajiv Goyal
Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Correspondence Address:
Aneesh Srivastav
Departments of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Srivastav A, Goyal R. Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer?. Indian J Urol 2006;22:166-7 |
Divrik T, Yildirim U, Eroglu AS, Zorlu F, Ozen H. Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer? J Urol 2006;175:1258-61.
 Summary | |  |
Transurethral resection of bladder tumors is the mainstay approach in the diagnosis and the treatment of bladder cancer. The first and the most important rule is the complete resection of the superficial bladder cancer. The objective of this study was to evaluate the potential benefit of a second transurethral resection, in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder. Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol, in which all patients prospectively received the 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. Out of 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. Although the second TUR dramatically changed the treatment strategy in a small percentage of cases, the authors strongly recommend performing a second TUR in all cases of primary pT1 disease, especially in high grade cases.
| Comment | | |
In this prospective study, the authors have evaluated the necessity of a second TUR in patients with newly diagnosed pT1 bladder cancer. Several recent studies have suggested that initial TUR may be incomplete in a significant number of cases.[1]
Cystoscopy should be performed anytime between 2-6 weeks of the first TUR. While many patients will have a residual tumor, resection of the previous site should be done even in the absence of visible disease.[2] Patients having a solitary tumor >3 cm or have multiple small / large tumors on initial resection, are more prone to have a residual disease. Similarly, patients who have high grade tumors on initial resection, are more susceptible to residual disease. Many patients can be up- staged after the second TUR and treatment strategy may change in these patients. Moreover, the 2nd TUR does not add to any significant morbidity. This series indicates that it is necessary to perform a second TUR in patients with newly diagnosed, high grade (G2-3), stage T1 bladder cancer for true staging and complete resection.
| References | | |
| 1. | Schips L, Augustin H, Zigeuner RE, Galle G, Habermann H, Trummer H. Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer? Urology 2002;59:220-2.  |
| 2. | Jakse G, Algaba F, Malmstrom PU, Oosterlinck W. A second-look TUR in T1 transitional cell carcinoma: Why? Eur Urol 2004;45:539-41. [PUBMED] [FULLTEXT] |
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