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Second Bladder Resection Warranted In T1 Tumours, And When Bladder Conservation Is Planned

Performing a second transurethral bladder resection might be of clinical use in specific cases among patients with bladder cancer, particularly those with T1 bladder tumours and in patients with more invasive tumours, when bladder conservation is planned.

M. Miladi and colleagues from the department of urology, Cochin Hospital, Paris, France, evaluated the usefulness of a second transurethral resection for the management of superficial and muscle-invasive bladder tumours. They reviewed the literature in this area in order to determine the pros and cons of this procedure.

According to the review, there are two shortcomings associated with transurethral resection: underestimating clinical stage and overlooking other lesions. A second procedure may help to correct these shortcomings in some cases. The researchers found that it corrects clinical staging errors in 9 to 49% of cases and detects residual tumours in 26 to 83% of cases.

Performing a second resection was found to be particularly useful in patients with stage T1 tumours. In these patients, the second procedure revealed that 2 to 28% of these tumours were in fact muscle-invasive, which resulted in a change in management.

A second resection is less useful for tumours that have already been identified as muscle-invasive. For these cases, the second procedure only appears to be helpful if bladder-sparing is being considered, since it can help to exclude the presence of tumour sites that would contraindicate the use of conservative treatment.
Eur Urol 2003 Mar;43:3:241-245. "The Value of a Second Transurethral Resection in Evaluating Patients with Bladder Tumours."

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