Value of Repeated Transurethral Resection in Superficial Bladder Cancer

Abstract

Abstract Background: Bladder cancer is a prevalent malignancy of the urinary system, with superficial tumors representing the majority of cases. Despite initial treatment with transurethral resection (TUR), these tumors have high recurrence rates (70-80%) and can progress to muscle-invasive disease in 20-30% of cases. Repeat transurethral resection (re-TUR) has been proposed as a method to improve staging accuracy and reduce the likelihood of recurrence by detecting residual tumor tissue. Methods: This prospective study included 100 patients with superficial bladder cancer (Ta and T1 stages) treated at the Urology Clinic of Istanbul Fatih Sultan Mehmet Training and Research Hospital between January 2005 and December 2006. Following the initial TUR, all patients underwent re-TUR within 4 to 6 weeks. Pathological findings from both procedures were analyzed to identify residual tumor presence and changes in tumor stage. Patients were followed up for 24 months to monitor recurrence rates and progression to muscle-invasive disease. Results: Re-TUR revealed residual tumor tissue in 40% of patients, with higher detection rates in T1 and Grade II tumors. Patients with residual tumors had a significantly higher recurrence rate (40%) compared to those without residual tumors (15%). Additionally, 20% of patients with residual tumors progressed to muscle-invasive bladder cancer, while no progression was observed in patients without residual tumors. Conclusion: Re-TUR plays a vital role in improving staging accuracy and reducing recurrence in patients with superficial bladder cancer. The presence of residual tumors significantly increases the risk of recurrence and progression, highlighting the importance of re-TUR, especially in high-risk patients. These findings support the routine use of re-TUR in managing superficial bladder cancer.