Role of second transurethral resection in determining residual tumor in nonmuscle- invasive bladder cancer
Objective: To determine the rate of residual tumors after first transurethral resection of nonmuscle-invasive bladder cancer, and to determine the factors associated with the presence of residual tumors and upstaging of nonmuscle-invasive bladder cancer.
Materials and methods: This was a prospective observational study of 43 patients of bladder cancer who had a diagnosis of nonmuscle-invasive bladder cancer following an initial transurethral resection. Demographic data and data on tumor characteristics were obtained. Patients underwent a second transurethral resection within 2 to 8 weeks. Histopathological findings at first and second resection were compared.
Results: There were 20 patients with Ta tumor and 23 patiens with T1 tumor at initial resection. Residual tumor was detected in 18 (41.86%) patients overall, 2 in patients with Ta tumor (10%) and 16 in patients with T1 tumor (69.5%). Tumors with T1 stage, high grade, size more than 3 centimeters and sessile growth pattern were seen to have significant association with the presence of residual tumors. Six patients with T1 disease upstaged to T2 disease after second resection (26%), while there were no upstaging with Ta tumors. Tumors with T1 stage, sessile configuration and size more than 3 centimeters were found to be significantly associated with upstaging.
Conclusion: Nonmuscle-invasive bladder tumors with T1 stage, high grade, size more than 3 centimeters and sessile growth pattern are associated with the presence of residual tumor and upstaging in second transurethral resection. A second transurethral resection should be considered in patients with these tumor characteistics.
Key word: nonmuscle invasive bladder tumor, TURBT, second TURBT
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