title: Results of repeated transurethral resection for a second opinion in patients referred for nonmuscle invasive bladder cancer: the referral cancer center experience and review of the literature.
abstract: OBJECTIVE
  We evaluated the results of a second transurethral resection (TUR) performed in patients referred after an initial TUR for nonmuscle invasive bladder cancer.
  
  
  METHODS
  From April 2001 to January 2008, patients who were referred for a second opinion and who underwent a second TUR at our institution were included in this study. Patients who had noninvasive bladder cancer and received the second TUR less than 8 weeks after the initial TUR were included in this analysis. The presence of residual tumor and changes of stage or grade from the two different TUR procedures were recorded and analyzed.
  
  
  RESULTS
  Fifty-six patients were evaluated in this study. The initial TUR specimens included the muscularis propria layers in 17 cases (30.4%), while the second opinion TUR specimens included the proper muscle layers in 47 cases (83.9%). Residual tumor was present in 16 of 25 (64.0%) patients with T(a) bladder cancer and in 20 of 30 (66.7%) patients with T(1) bladder cancer. Overall upstaging by the second TUR occurred for 9 patients (16.1%). Of 25 patients with T(a) bladder cancer, the second TUR confirmed the lamina propria invasion in one (4.0%) and muscle invasion in one (4.0%). The second TUR confirmed the muscle invasion in 7 of 30 (23.3%) patients with T(1) bladder cancer. Nine patients (16.1%) had their treatment strategy changed.
  
  
  CONCLUSIONS
  The previous results and our experiences suggest that a second TUR is recommended to reduce the chance of residual tumor and staging error because of nonstandardized TUR in the patients referred to an academic or referral center for a second opinion, irrespective of previous tumor stage.
authors.affiliation: Urology Oncology Clinic, Center for Specific Organ Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Kyung Seok
authors.initials: KS
authors.lastname: Han
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Joung
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
authors.forename: Ho Kyung
authors.initials: HK
authors.lastname: Seo
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Chung
authors.forename: Won Seo
authors.initials: WS
authors.lastname: Park
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D012017:Referral and Consultation; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*