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.