title: Significance of second transurethral resection on patient outcomes in muscle-invasive bladder cancer patients treated with bladder-preserving multimodal therapy.
abstract: OBJECTIVE
  Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT.
  
  
  METHODS
  We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study.
  
  
  RESULTS
  Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52-81) years and 60.3 (38.3, 6-159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS.
  
  
  CONCLUSIONS
  Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Evren
authors.initials: E
authors.lastname: Suer
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey. dr.nhamidi86@gmail.com.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Hamidi
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Mehmet Ilker
authors.initials: MI
authors.lastname: Gokce
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Gulpinar
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Turkolmez
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Beduk
authors.affiliation: Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Sumer
authors.initials: S
authors.lastname: Baltaci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: Bladder cancer; Bladder preserving; Multimodal therapy; Second resection