Abstract
The success of treatment in non-muscle-invasive bladder cancer (NMIBC) depends on the biologic characteristics of the tumor and on the treatment strategy, which must be appropriately selected and correctly performed. Transurethral resection of the bladder (TURB) is the initial and critical step in the management of bladder tumors.
The aim of the procedure is to establish the histologic diagnosis, to determine the tumor stage and grade, and to achieve complete removal of papillary non-muscle-invasive tumors. Although TURB is a frequently performed procedure that should be familiar to all urologists and is based on principles that have not changed for decades, its results are far from optimum, and the diagnostic and therapeutic purposes are not always achieved.
Tumors are frequently overlooked and left behind during initial resection, or, more dangerously, their depth of invasion can be underestimated. To overcome these limitations, a second transurethral resection (TUR) performed after 2-6 wk was incorporated into our treatment algorithms.
The current version of the European Association of Urology (EAU) guidelines recommends considering a second TUR if there is suspicion that the initial resection was incomplete (eg, when multiple or large tumors are present, when the pathologist reported no muscle tissue in the specimen). Furthermore, second TUR should be performed when a high-grade non-muscle-invasive tumor or a T1 tumor is detected at initial TUR.
This relatively strict recommendation, which affects a large proportion of NMIBC patients, was a matter of sharp discussion within the guidelines group as well as with reviewers of European Urology and at many meetings afterward. To target the essence of the problem, many points should be mentioned and discussed.