title: Second transurethral resection after Ta high-grade bladder tumor: a 4.5-year period at a single university center.
abstract: OBJECTIVE
  We evaluated the results of second transurethral resections of the bladder (TURB) after pTa high-grade bladder cancer over a 4.5-year period.
  
  
  METHODS
  From July 2007 to December 2011, 2,159 TURBs were performed at our institution, of which 1,143 were initial resections for primary bladder tumor or recurrence. Of these, 142 revealed pTa high-grade bladder cancer, and here we investigated tumor characteristics of initial TURB and results of second resection.
  
  
  RESULTS
  The incidence of pTa high-grade tumor was 12.4% (n = 142). Of 87 patients who underwent a second resection, tumor was found in 36 (41.4%); tumors were multifocal in 25 (69.4%) and <3 cm in 29 (80.6%). Tumor was detected at the primary site in 38.9%, at other locations in 22.2%, and at both in 38.9%. Histology revealed pTa low-grade in 13 (14.9% of 87), pTa high-grade in 15 (17.2%), and pT1 in 5 (5.7%) patients. No muscle-invasive tumor was detected. A significant association was found for the number of tumors at initial TURB: in patients with tumor at second resection, 55.1% had had multiple tumors at first resection, more than twice those with solitary tumor (23.7%) (0.004).
  
  
  CONCLUSIONS
  In our study, Ta high-grade tumors show a relevant rate of persistent tumor at second resection, most of them located at the primary tumor site. As recommended by the American and European clinical guidelines, patients with Ta high-grade tumor should undergo second resection.
authors.affiliation: Department of Adult and Pediatric Urology, Center for Clinical Research (CCR), University of Witten/Herdecke, HELIOS Hospital, Wuppertal, Germany.
authors.forename: David A
authors.initials: DA
authors.lastname: Lazica
authors.forename: Stephan
authors.initials: S
authors.lastname: Roth
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Brandt
authors.forename: Stefanie
authors.initials: S
authors.lastname: Böttcher
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mathers
authors.forename: Burkhard
authors.initials: B
authors.lastname: Ubrig
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult