OBJECTIVES: To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS). PATIENTS AND METHODS: In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette-Guérin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical outcomes were compared across the four groups. RESULTS: Re-TUR had a positive impact on recurrence, progression, CSS and OS only if muscle was not present in the primary TUR specimen. Adjusting for the most important prognostic factors, re-TUR in the absence of muscle had a borderline significant effect on time to recurrence [hazard ratio (HR) 0.67, P = 0.08], progression (HR 0.46, P = 0.06), CSS (HR 0.31, P = 0.07) and OS (HR 0.48, P = 0.05). Re-TUR in the presence of muscle in the primary TUR specimen did not improve the outcome for any of the endpoints. CONCLUSIONS: Our retrospective analysis suggests that re-TUR may not be necessary in patients with T1-HG/G3, if muscle is present in the specimen of the primary TUR.

Department of Experimental and Clinical Medicine University of Florence Florence Italy

Department of Surgical Oncological and Stomatological Sciences University of Palermo Palermo Italy

Department of Surgical Science John Radcliffe Hospital University of Oxford Oxford UK

Department of Urology Academic Hospital Uppsala University Uppsala Sweden

Department of Urology Centre Hospitalier Universitaire La Milétrie University of Poitiers Poitiers France

Department of Urology Fundacio Puigvert University of Barcelona Barcelona Spain

Department of Urology Mayo Clinic Rochester MN USA

Department of Urology Memorial Sloan Kettering Cancer Center New York NY USA

Department of Urology Motol Hospital University of Praha Praha Czech Republic

Department of Urology Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology Rabin Medical Centre Tel Aviv Israel

Department of Urology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

Department of Urology Santa Chiara Hospital Trento Italy

Department of Urology Sismanoglio Hospital University of Athens Athens Greece

Department of Urology Weill Medical College of Cornell University in New York City New York NY USA

Dipartimento di Urologia Università Vita Salute Ospedale S Raffaele Milan Italy

Facharzt fur Urologie Abteilung fur Urologie Chirurgische Universitats klinik Freiburg Germany

Formerly Department of Biostatistics EORTC Headquarters Brussels Belgium

Genetic and Molecular Epidemiology Group Spanish National Cancer Research Centre Madrid Spain

Oncologic and Reconstructive Urology Department of Urology University Hospitals Leuven Leuven Belgium

Policlinico Tor Vergata University of Rome Rome Italy

Urology Clinic Città della Salute e della Scienza di Torino University of Studies of Turin Turin Italy

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Second TURB, restaging TURB or repeat TURB in primary T1 non-muscle invasive bladder cancer: impact on prognosis?

Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought