title: Results of second transurethral resection for high-grade T1 bladder cancer.
abstract: BACKGROUND
  The aim of this study was to examine the histological outcome and potential therapeutic benefit of second transurethral resection (TUR) for high-grade T1 bladder cancer.
  
  
  METHODS
  The subjects were 171 patients who underwent initial TUR between January 1993 and December 2013, and were diagnosed with high-grade T1 bladder cancer. Second TUR was performed within 4-6 weeks after the initial resection. Intravesical recurrence, invasive intravesical recurrence, and disease-free, progression-free, and overall survival were examined between second TUR group and no second TUR group.
  
  
  RESULTS
  Of the 171 patients, 79 (46.2%) underwent second TUR. Histological findings from second TUR were no cancer in 33 (41.8%), carcinoma in situ in 18 (22.9%), Ta in 15 (19.0%), T1 in 12 (15.2%), and muscle invasive bladder cancer (T2) in 1 case (1.3%). The 5- and 10-year intravesical recurrence-free survival rates were 72.0% and 57.4%, respectively, and the disease-free survival rates at these times were 69.7% and 49.6%, respectively. Second TUR had no influence on intravesical recurrence, regardless of the use of Bacillus Calmette-Guerin (BCG) therapy. No BCG therapy and recurrent cancer were significantly associated with intravesical recurrence in multivariate analysis. Recurrent cancer was also a significant risk factor for invasive intravesical recurrence. BCG therapy significantly improved disease-free survival. Second TUR was a significant factor in overall survival. In the histological results for second TUR, no cancer and Tis cases had reduced intravesical recurrence compared to Ta and T1 cases.
  
  
  CONCLUSIONS
  Second TUR allows more accurate staging and pT0 cases in second TUR have a better outcome, indicating a possible therapeutic benefit of the procedure.
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hashine
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Ide
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakashima
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Tadanori
authors.initials: T
authors.lastname: Hosokawa
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Iku
authors.initials: I
authors.lastname: Ninomiya
authors.affiliation: Department of Pathology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Teramoto
keywords: Bacillus Calmette–Guérin; high-grade T1 bladder cancer; second transurethral resection
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