Values of Early Second Transurethral Resection in Patients with Superficial Urinary Bladder Tumors

Abstract

orldwide, bladder cancer (BCa) is the seventh most common malignancy in men and the seventeenth most common malignancy in women(Grasso and Eur Urol Suppl 2008). Approximately 75-85% of all patients with BCa have disease confined to the mucosa (stage Ta or stage carcinoma in situ [CIS]) or submucosa (stage T1). This group of tumours is referred to as non-muscle-invasive or superficial BC as opposed to muscle-invasive disease staged as T2-T4 (Rigaud Urol et al., 2002). Transurethral resection (TUR) of bladder tumours is the mainstay in the diagnosis and treatment of bladder cancer. The first and most important rule is the complete resection of the superficial tumours. This procedure is not only mandatory for adequate staging but also crucial in delaying or preventing tumour recurrence and progression (Brauers, et al., 2001). Transurethral resection is used primarily in muscle-invasive bladder cancer to establish the diagnosis and local extent of the disease. The use of Transurethral resection tumor for definitive treatment of non muscle-invasive bladder cancer is predicated on tumor volume, multifocality, and associated carcinoma in situ (CIS). Understaging of the depth of tumor involvement occurs in up to 40% of cases. Nevertheless, several series have shown that TURT provides disease control, particularly in patients with lower clinical disease stages (Ricos et al., 1992). The classification of superficial bladder tumor or better-known nonmuscle-invasive bladder tumors is based on two pillars: (1) the clinical stage following the TNM classification differentiating between Ta, which includes tumors not invading the submucosa, and T1, which invades the submucosa, but not the muscularis propria; and (2) the histological grade that refers to the 1973 WHO grading system based on the microscopic appearance of cancer cells. However, the major limitation of this classification is the vague definition and the lack of specific histological criteria without a reliable inter- and intraobserved correlation (Murphy et al., 2002). Transurethral resection tumor is the key diagnostic modality to determine whether patients have bladder cancer that can be treated locally or requires more aggressive, surgical treatment. While TUR is an extremely common urologic procedure, it is not without complications (Hollenbeck, et al., 2006).