Repeated transurethral resection of recurrent superficial bladder tumors - Does it affect the spread and stage of the tumor?

Objectives: This prospective study was done to demonstrate the effect of repeated resection of superficial bladder tumors (TURT) on deep malignant cell infiltration in bladder wall. Material and Methods: Thirty-six patients underwent radical cystectomy for invasive bladder cancer, 16 patients originally had superficial cancer that became invasive after repeated TURT (group 1) and the other 20 patients (group 11) presented with invasive bladder cancer from the start. Each cystectomy specimen was subjected to a thorough histopathological study. Results: There was a statistically significant difference in pattern of local spread of malignant cells between the two groups. Isolated clusters of malignant cells in-between normal bladder muscle fibers, isolated subserosal malignant deposits as well as cells reaching the adjacent cervix uteri were found only in group 1. Intravesical pressure was measured in another 10 patients during TURT and was found to be high reaching up to 80 cm H2O. Conclusions: We conclude that some malignant cells penetrate through the denuded urothelium during TURT by the effect of high intravesical pressure. This may be responsible, among other factors, for tumor recurrence with deeper stages.