Study population and protocol
With the permission of the local ethics committee, the patients to whom re-TUR operation was performed between 2013-2020 in our clinic were retrospectively included to the study. Patients underwent TUR-B operation under general or spinal anaesthesia by the continuous flow 27 French 30 ° optic resectoscope instrument and video camera system (Karl StorzTM, Tuttlingen, Germany).
The patients who were at intermediate and high-risk classification were included to the study. The patients with Ta_Low grade pathology that present one of these parameters; multiple, recurrent or >3 cm tumors were considered as intermediate risk NMIBC. Therefore re-TUR was also applied for these Ta_Low grade patients who were classified in the intermediate risk group. On the other hand, the patients who had low-risk NMIBC, patients with MIBC, patients with in-complete TUR-B and the patients who had no muscle tissue in the pathologic specimen, were excluded from the study.
The re-TUR operation was performed approximately 4-6 weeks after the index TUR-B for intermediate and high-risk NMIBC patients. During re-TUR operation, resection was performed from the same area of the primary tumor including the deep muscle layer, regardless of the residual or recurrent tumour. The re-TUR specimen was checked for any residual tumor and whether there was a change in tumour stage or grade. All the patients who were not upstaged to MIBC received standard BCG immunotherapy.
Both TUR-B and re-TUR pathology characteristics including tumor stage, tumor grade, tumor size, tumor number, presence of lymphovascular invasion (LVI), presence of CIS, presence of variant pathology and the tumor risk status were analysed. The Re-TUR positivity (residual tumor) of the patients were evaluated and analysed according to these variables.