Repeat transurethral resection for non-muscle-invasive bladder cancer: a contemporary series.
OBJECTIVE
To evaluate the depth of transurethral resections of bladder tumour (TURBT), residual cancer rates and up-staging rates in a contemporary Australian series.


METHODS
Specimen reports from a single, major reporting pathology centre, servicing a group of urological oncologists in Sydney were obtained for TURBTs performed between October 2008 and February 2013. We examined the depth of TURBT, rates of repeat-TURBT (re-TUR) and residual cancer rates at the 3-6 month check cystoscopy.


RESULTS
One thousand and two hundred and nine transurethral resection specimens retrieved during this period were analysed. There were 162 (13.4%) T1 specimens and 631 (52.2%) Ta specimens, 218 (34.5%) of which were high grade. Muscularis propria was present in 506 (41.9%) specimens in total and in 151 (39.7%) of 380 high-risk specimens (high grade Ta, T1). Of the 380 high-risk non-muscle-invasive tumours, 85 (22.4%) proceeded to re-TUR. Of the 48 T1 specimens and 37 Ta high grade specimens that proceeded to re-TUR, 7 (14.6%) and 1 (2.7%) respectively were upstaged to muscle-invasive disease. Rates of residual disease/early recurrence at 3-6 months was significantly better for those with re-TUR compared to those without 56.8% vs 82.5% (P < 0.001) for Ta high grade and 39.6% vs 84% (P = 0.028) for T1 tumours respectively.


CONCLUSIONS
Re-TUR rates in high-risk non-muscle-invasive bladder cancer are low. However in a contemporary series, the upstaging rates are low, but residual cancer rates high, supporting the need for re-TUR in this population.
Department of Urology, St George Hospital, Sydney, NSW, Australia.
Rasha
R
Gendy
Douglas Hanley Moir Pathology Laboratory, Sydney, NSW, Australia.
Warick
W
Delprado
Department of Urology, St Vincent's Hospital, Sydney, NSW, Australia.
Phillip
P
Brenner
Department of Urology, Westmead Hospital and Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
Andrew
A
Brooks
Department of Urology, Concord Hospital, Sydney, NSW, Australia.
Graham
G
Coombes
Department of Urology, St George Hospital, Sydney, NSW, Australia.
Paul
P
Cozzi
Department of Urology, St George Hospital, Sydney, NSW, Australia.
Peter
P
Nash
Department of Urology, Westmead Hospital and Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
Manish I
MI
Patel
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009130:Muscle, Smooth / Q000473:pathology; D057605:Natural Orifice Endoscopic Surgery; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012086:Reoperation; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
NMIBC; high risk; re-operation; transurethral resection; urinary bladder neoplasms