Should a Second Transurethral Resection Be Performed in All Patients with T1 or High-Grade Non-Muscle-Invasive Bladder Cancer?

Context: Transurethral resection (TUR) is a critical step in the management of non-muscle-invasive bladder cancer (NMIBC). Because of the high risk of tumour persistence and understaging, the routine second TUR performed after 2-6 wk is recommended by European Association of Urology guidelines in all patients with T1 or high-grade NMIBC. Objective: To summarise arguments that support the recommendation of routine second TUR in all patients with T1 or high-grade NMIBC. Evidence acquisition: Data and arguments were retrieved from a critically selected list of articles and abstracts dealing with the surgical treatment of NMIBC. Evidence synthesis: In patients with T1 tumours, the risk of tumour persistence and tumour understaging detected by the second TUR was 33-78% and 2-28%, respectively. The pathologic finding achieved by second TUR can modify the treatment strategy in a significant number of patients. Correct staging in NMIBC enables the selection of the optimal treatment modality and improves results. Conclusions: The second TUR confirmed the presence of residual cancer and tumour understaging in a significant number of T1 and high-grade tumours. This is a strong argument that supports the recommendation of second TUR in patients with T1 or high-grade NMIBC. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.