The authors felt this is a big problem because there is no standardised practice on re-resection following initial transurethral resection of bladder tumour (TURBT). Getting detrusor muscle in the first specimen is thought to be important. However muscle is not always present and this does vary with operator experience. Most recurrence happens at the original site, which highlights the importance of an oncologically sound first resection. This is the largest systematic review on this subject, including a total of 8409 persons with high grade Ta and T1 bladder cancer. Presence of detrusor muscle in the initial TUR histology specimen ranged from 30-100%. Residual tumour at re-TUR was found in 17-67% of patients following Ta and in 20-71% following T1 cancer.

Most residual tumours were found at the original resection site. Upstaging occurred in 0-8% (Ta to T1) and 0-32% (T1 to T2) of cases. Recurrence for Ta was 16% in the re-TUR group versus 58% in the non-re-TUR group. For T1, recurrence ranged from 18% to 56%, but no clear trend was identified between re-TUR and control. The conclusions are mixed, as residual tumour is common after TUR for high-risk non-muscle invasive bladder cancer (NMIBC). There is still no absolute evidence that re-TUR is superior to prevent upstaging and recurrence. However, for cancers initially staged as T1 the re-TUR helps in the diagnosis of this residual cancer and may improve outcomes.

Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review.
Cumberbatch MGK, Foerster B, Catto JWF, et al.
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Nishant Bedi

Northwick Park Hospital.

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