Impact of second-look TURBT on high grade recurrence and intravesical therapy in high-risk non-muscle-invasive bladder cancer: A 20-year experience.

OBJECTIVE

To describe our 20-year experience with second look Transurethral Resection of Bladder Tumor (SL-TURBT) for high-risk non muscle invasive bladder cancer (NMIBC), and whether it was associated with better response to adjuvant intravesical therapy (IVT) and prognosis.

METHODS

Retrospective review of our quality assurance TURBT database between 2000 and 2024. All patients with high risk NMIBC who received IVT were included in the study. SL-TURBT was defined as TURBT within 8 weeks of the initial TURBT or if labelled by the clinician as such. Patients were divided into those who received SL-TURBT vs. those who did not. Patients were followed with cystoscopy and urine cytology every 3 months for the first 2 years, then every 6 months for years 3 to 5, then annually thereafter. Annual upper tract imaging was also performed. Kaplan-Meier method was used to depict high grade recurrence (HGRFS) and progression-free (PFS) survival.

RESULTS

Of 853 patients were included in the study, 41% received SL-TURBT. Median time between initial and re-TURBT was 5.9 weeks (IQR 4.0-7.1 weeks). Indications for SL-TURBT included absence of detrusor in specimen (35%), T1 high grade disease (32%), Ta high grade (13%), incomplete resection (16%) and CIS (4%). Patients who received IVT exhibited improved 3 years' HGRFS with SL-TURBT (58% compared to 40% without SL-TURBT, log rank P = 0.008). There was no significant difference in PFS.

CONCLUSION

Patients with high risk NMIBC who received a SL-TURBT prior to IVT exhibited improved HGRFS compared to those who received IVT without SL-TURBT.