INTRODUCTION
Bladder cancer (BC) is the 7th most common cancer in males and 13th most mortal cancer in both males and females1. Smoking, genetic factors, chemical agents and many other factors are the risk factors for the aetiology of BC2-4. Approximately 75% of BC is non-muscle invasive bladder cancer (NMIBC) and 25% is muscle invasive bladder cancer (MIBC) at the time of diagnosis5. Differentiating the NMIBC from MIBC is so important because the treatment protocol is totally different. If the patients were misdiagnosed as NMIBC instead of MIBC, it would be catastrophic for the treatment strategy. To prevent this situation, re-TUR (re-transurethral resection) is performed 2-6 weeks after the index TUR-B (transurethral resection of bladder) operation6. Complementary TUR-B should be performed, if there is no muscle tissue at pathology specimen or the index TUR-B is incomplete. However re-TUR is a totally different procedure from complementary TUR-B. Re-TUR is performed after complete TUR-B to prevent misclassification or to resect undetected tumors after the index TUR-B7.
The European Urology Association (EAU) guidelines defined Ta_Low grade tumors as low-risk NMIBC category, which means that the risk of progression is low for this group. On the other hand, T1 tumors, high-grade tumors, carcinoma in situ (CIS) pathologies and all features including multiple, recurrent and large (>3 cm) tumors are in the high-risk NMIBC group. The rate of progression in this group is significantly higher than low-risk group8-9. Pathologies between these two groups are considered to be intermediate-risk group for NMIBC. Re-TUR is proposed to be unnecessary in low-risk NMIBC. On the other hand, in high-risk NMIBC, re-TUR is routinely recommended. However there is no exact recommendation about the feasibility of re-TUR for intermediate risk NMIBC9.
In this study, we aimed to evaluate the re-TUR pathologies and the comparison of pathology results between TUR-B and re-TUR for intermediate and high-risk NMIBC. In addition we aimed to evaluate the more valuable patient groups for re-TUR and factors affecting re-TUR pathology. We also aimed to assess the influence of re-TUR on recurrence and progression for intermediate and high-risk NMIBC patients.