Value of Second look Cystoassessment After TURBT of Non-mucle INVASIVE Bladder Tumors

Abstract

This is a prospective study, including 33 patients presented at department of urology, Ain Shams University hospital with NMIBC (non muscle invasive bladder cancer) who were diagnosed on clinical and pathological basis. In our study, objectives were to evaluate the values of 2nd look cystoassessment in detecting recurrent tumors or changing the stage post initial TURBT. All patients underwent complete preoperative clinical evaluation with detailed history taking, full examination, laboratory investigation (including urine analysis and routine preoperative laboratory investigations) and radiological investigations. The initial TURBT was performed in standardized manner. All visible tumors were completely resected with a deep muscular sample taken from the tumor base as well as tumor margins, and they were taken as separate specimen. Tumor were staged according to TNM classification 2009 and graded according to the WHO 2004 classification. The 33 patients were statistically performed as regard age, sex, risk factors, main presentation, tumor stage and grade. All patients underwent 2nd look cystoassessment after complete resection in the initial TURBT. Finding of 2nd look cystoassessment showed that 11 patients (33.3%) had no tumors (negative second look), while 22 patients (66.7%) had positive tumors {recurrent tumors}. recurrent tumors had a statistically positive significance with the initial tumor size ≥ 3 cm, stage (T1), and Grade (High grade), multiplicity of tumors. Second look cystoassessment resulted in a change in treatment strategy for 5 patients (15.2%) of 33 patients. 3 patients upstaged to muscle invasive disease, two had radical cystectomy and the one of them referred to bladder preservation protocol. There was no significant statistical difference in the rate of complication between the first TURBT and 2nd look cystoassessment in this study. All these complication was treated conservatively and patients with bleeding did not necessitate blood transfusion.

Conclusion From our study, we can conclude that: Second look cystoassessment achieve optimal local control on NMIBC by detecting recurrent tumors post initial TURBT. Second look cystoassessment can change the treatment strategy of patients by correction of stage of initial TURBT. Second look cystoassessment is a safe procedure with no significant morbidity or complications. Second look cystoassessment should be an integral part in management of patients with NMIBC in a subset of patients especially for tumor size ≥ 3cm, stage T1, high grade and multiple tumors because of the higher risk for having recurrent tumors and staging errors. No doubt that surgeon experience plays important role in avoidance of any residual or missed tumors, although we didn’t mention it in our study but it should be recommended in further studies.