This was a prospective study of 100 consecutive patients with a newly diagnosed superficial bladder tumour who underwent a second look transurethral resection of bladder tumour (TURBT) two to six weeks post initial resection. This essentially included pTa multiple and / or high grade tumours and pT1 tumours as long as muscle had been included in the initial resection. Tumours were graded according to the World Health Organization (WHO) 2004 system. Twenty-five patients were excluded from the analysis as the initial sample did not include muscle and a further 11 patients were excluded as they had a single focus of low-grade disease. Mitomycin C does not appear to be given routinely at initial resection, however, if multiple tumours were seen then a course of Mitomycin C was given prior to the second resection. On second look 40% (30) patients had residual tumours and upstaging occurred in 24% (18) of cases. Residual or further disease was more likely to be upgraded if the initial disease was multi-focal. The authors support a second-look cystoscopy in all superficial bladder cancers except for those with solitary, small low-grade pTa tumours. This paper is interesting as second look cystoscopy is certainly topical but it would be useful here to refer to the findings of Gaya et al. This group suggests that if there is adequate muscle present in the initial sample and the tumour is low-grade a second look cystoscopy is not required. These studies suggest therefore that larger studies need to be done to clarify this. Also noteworthy is that El-Barky et al. don’t appear, from their paper, to use Mitomycin C at the time of first resection which may have influenced their outcomes. 

The importance of second-look transurethral resection for superficial bladder cancer.
El-Barky E, Sebaey A, Eltabey M, et al.
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Ann Crump

Central Manchester Foundation NHS Trust

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