Second Transurethral Resection of Bladder Tumors : Review of the Literature and Single-Center Results

Purpose: We reviewed the literature related to the importance of the second transurethral resection of bladder tumors (TURBT) and we described the results of second TURBTs in a single center. Material and methods: We made a retrospective analysis of the patients submitted to second TURBT between April 2013 and September 2016. The criteria were: incomplete initial TURBT; T1 tumors; high-grade tumors; no detrusor muscle in the specimen after initial resection. Our analysis focused on tumor staging, tumor grade, the presence of detrusor muscle in the specimen, and complete resection of visible tumor. An extensive review of literature related to the second TURBT was also performed. Results: We performed 99 second TURBTs. 80.8% of the patients were male 19.2% were females. The mean age was 69.24 ± 12.21 years. Most of the patients were current (32.5%) or former (48.2%) smokers. The mean time from the beginning of symptoms to surgery was 12.22 ± 9.82 months. The mean time elapsed between the two TURBTs was 7.24 ± 2.51 weeks. The main symptom at diagnosis was macroscopic hematuria (67.4%). On the first TURBT, 61.6% patients presented as Ta staging and 38.4% presented as T1. Upstaging rate after second TUBRT was 14.1%. Regarding tumor grade, the first TURBT presented: 36.4% of low-grade tumors; 63.6% of high-grade tumors. The upgrading rate was 2.0%. In the first TURBT, the presence of detrusor muscle rate was 92.9% and complete resection rate was 70.7%. Upstaging and detrusor muscle absent in the TURBT had no significant association (OR: 2.667, p = 0.257), however, upstaging and incomplete tumor removal had a statistically significant association (OR: 4.063, p = 0.024). Conclusion: Second TURBT has a primordial role in bladder cancer management and a better outcome of the patient depends largely on its correct use.