High Risk Superficial Bladder Tumours: Is a Second Transurethral Resection after Intravesical Bcg Necessary?

According to some authors, residual tumour rate after superficial bladder cancer transurethral resection varies from 4–78%; among high risk superficial tumours (TaG3, T1G3, Tis) managed by transurethral resection of the bladder (TURB) and adjuvant immunotherapy, residual tumour rate varies from 57–76%.

This study was aimed to evaluate residual tumour and/or tumour recurrence in 56 patients diagnosed with high risk superficial bladder tumour, who underwent transurethral resection, adjuvant 6-weekly course of intravesical bacille Calmette-Guérin (BCG) and second TURB on the first resection sites, and in other sites suspicious for recurrence. Overall, 7/56 patients (12.5%) had residual tumour and/or recurrent disease at second TURB; no histological progression was recorded. Disease persistence or recurrence was not related to tumour multifocality at first diagnosis.

Our results appear to be consistent with other recent experiences, reporting low rates of residual tumour and disease progression in superficial bladder tumours after a first adequate resection and adjuvant immunotherapy.

Thus, our current practice in management of high risk superficial bladder tumour is oriented towards routine cystoscopy within 3 months after first bladder tumour resection, completed by cold biopsies on previous resection sites.

To our opinion, this approach provides adequate diagnostic reliability besides sparing the costs of a new resection and improving patients quality of life.