title: The need for re-TUR of the bladder in non-muscle invasive bladder cancer: risk factors of tumor persistence in re-TUR specimens.
abstract: OBJECTIVE
  This study evaluated the need for re-TUR of the bladder in non-muscle invasive bladder cancer (NMIBC) with complete transurethral resection (TUR) and examined the risk factors for disease occurrence in re-TUR of the bladder.
  
  
  METHODS
  A cohort of 211 patients diagnosed consecutively of NMIBC (July 2009 to October 2011) underwent re-TURB 4-6 weeks after the initial TURB. Association with tumor presence in re-TURB of the following parameters was analyzed: sex, primary/recurrent, number, size, stage, grade, association of carcinoma in situ, early instillation of Mitomycin C, and its classification according to the EORTC risk groups.
  
  
  RESULTS
  Fifty-seven (27%) cases exhibited residual tumors in the re-TURB and understaging was observed in 3 (1.4%) patients. The EORTC classified 151 (71.6%) patients as high risk; 124 (58.7%) patients received postoperative instillations of Mitomycin C. 31.8% of high risk patients exhibited tumors in the re-TUR compared to 14% of the low/intermediate risk (P<0.05). A total of 19.4% of patients with early instillation of Mitomycin C had tumor in re-TURB compared to 38.4% of patients without it (P<0.05). Multivariate analysis showed that high-risk tumors behaved as an independent risk factor for the tumor presence in re-TURB (HR=12.65, P=0.008), but early postoperative instillation of Mitomycin C was a protective factor (HR=2.16, P=0.02). The limitations of the study are the absence of randomization and its unicentric character.
  
  
  CONCLUSIONS
  Patients who were at a high risk of tumor recurrence and/or progression according to the EORTC classification exhibited a higher percentage of tumors in re-TURB. Therefore, these patients are optimal candidates for re-TURB.
authors.affiliation: Hospital Universitario Infanta Elena Hospital Universitario Fundación Jiménez Díaz Valdemoro/Madrid, Spain - adrhusillos@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Husillos Alonso
authors.forename: E
authors.initials: E
authors.lastname: Rodríguez Fernández
authors.forename: F
authors.initials: F
authors.lastname: Herranz Amo
authors.forename: E
authors.initials: E
authors.lastname: López López
authors.forename: J
authors.initials: J
authors.lastname: Aragón Chamizo
authors.forename: D
authors.initials: D
authors.lastname: Ramírez Martínez
authors.forename: R
authors.initials: R
authors.lastname: Durán Merino
authors.forename: C
authors.initials: C
authors.lastname: Hernández Fernández
mesh_terms: D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*