The Value of A Second Transurethral Resection in Patients with Superficial Bladder Cancer

Transurethral tumor resection (TUR) is the first treatment step in bladder cancer. It is a diagnostic, prognostic and also the-rapeutic procedure. Ali further treatment decisions, if any, are based on the results of the TUR. However, the histologic diagnosis may be compromised by fulguration of the surgical specimen or by incomplete resection of the tumor and this increases the risk of early recurrence and progression. Therefore some investigators suggest second TUR routinely in ali cases of superficial bladder cancer. However, the role of second TUR is stili controversial. The objective of this study was to evaluate the value of second TUR in patients vvith superficial bladder cancer. From January 2004 to January 2005 a total of 20 patients vvith superficial bladder cancer (stage Ta and Tl) undervvent second TUR in our clinic. Ali second TUR were video assisted and 26 F 30° optic Kari Storz™ resectoscopes were used. Firstly the visible tumor was resected, also resection of tumor margin and tumor base to the dee-per muscle layer were performed. Subsequent operations were performed vvithin 2 to 6 weeks. The histopathologic reports of the first and second TUR specimens of ati patients included in our study were revievved. The rate of residual tumor tissue after the initial resection was determined and correlated vvith the tumor characteristics and histologic findings during the first operation. No operative com-plication was visualized. Of the 20 patients 3 (15%) were female, 17 (85%) male. The mean age of femaie and male patients were 61.7 and 59.6, respectively. 55% of patients were in stage Ta and 45% in stage T1. Divided by grade, 6 (30%) patients had grade 1, 14 (70%) had grade 2 tumor. Nine patients had unifocal, 11 had multifocal tumor. Second TUR 2-6 vveeks later showed persisting carcinoma in 7 of 20 patients. Of these 7 patients 5 had Ta, 2 had T1 tumor. No upstaging was observed in any patients. Persisting tumor found at second TUR was independent of patient's age and sex, but most of patients vvith residual tumor (86%) had multifocal disease. Retrospective studies have shown that second TUR some weeks later stili revealed tumor in 30% to 70% of patients and 80% ivere found on the initial localisation. Also surgeon's experience was found to have no effect on the rate of tumor detected at the second TUR. Significant proportion of superficial bladder cancer recurrences might be due to high rate of tumor left behind. Second TUR may be useful as it provides a better evaluation of clinical stage and seeks out residual tumor. Also it may provide better long-term recurrence free survival and may decrease the need for radical cystectomy. In the light of our data and literature, second TUR is a saf e procedure vvith low morbidity and virtually no complication, so should beco-me a routine procedure in patients vvith superficial bladder cancer. To evaluate the true impact of second TUR, larger prospecti-ve randomized trials should be conducted.