title: Positive urine cytology and carcinoma in situ prior to second transurethral resection of the bladder correlate with positive second resection histology and the need for subsequent cystectomy.
abstract: OBJECTIVE
  A second transurethral resection of the bladder (TURB) is recommended for high-grade bladder cancer (BC) yet yields negative results in over half of the cases. Aim of this study was to identify prognostic indicators of a positive second TURB or the need for a subsequent cystectomy.
  
  
  METHODS
  The study cohort consisted of 101 patients with high-risk BC (T1G2-3, TaG3, Carcinoma in situ) who underwent second TURB after complete first resection. Age, gender, stage, grade, carcinoma in situ (Cis), tumour number, size, localization, surgeon experience and bladder wash cytology before the second TURB were considered as potential prognostic factors of positive histology at second TURB or the need for subsequent cystectomy.
  
  
  RESULTS
  The mean follow-up period was 23.8 months. The study cohort was comprised of 82 males and 17 females. Cytology on bladder wash urine was performed in 85/101 patients and in 39 was negative; 55.5 % of second TURB specimens were negative. The rate of upstaging to ≥T2 was 4.9 %. Cis (OR 8.4; 95 % CI 1.3-54.2; p = 0.03) and positive cytology (OR 6.8; 95 % CI 2.3-19.9; p = <0.01) were independent prognostic factors of a residual tumour in the second TURB. Cytology also correlated with clinical need for cystectomy in the follow-up (HR 6.5; 95 % CI 1.3-30.5; p = 0.02).
  
  
  CONCLUSIONS
  CIS and positive cytology prior to second TURB increased the risk of a positive second TURB specimen. A positive cytology also increases the risk of the subsequent need for cystectomy.
authors.affiliation: Department of Urology, Central Hospital of Bolzano, Lorenz-Boehler street 5, 39100 Bolzano, Italy. mlodde@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Lodde
authors.forename: R
authors.initials: R
authors.lastname: Mayr
authors.forename: T
authors.initials: T
authors.lastname: Martini
authors.forename: E
authors.initials: E
authors.lastname: Comploj
authors.forename: S
authors.initials: S
authors.lastname: Palermo
authors.forename: E
authors.initials: E
authors.lastname: Trenti
authors.forename: E
authors.initials: E
authors.lastname: Hanspeter
authors.forename: H M
authors.initials: HM
authors.lastname: Fritsche
authors.forename: C
authors.initials: C
authors.lastname: Mian
authors.forename: A
authors.initials: A
authors.lastname: Pycha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020728:Transurethral Resection of Prostate; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D014556:Urine / Q000166:cytology*; D019459:Urothelium / Q000473:pathology*