ROLE OF RETURBT IN TA BLADDER TUMOURS OUR EXPERIENCE IN TERTIARY HEALTH CARE.
Main Article Content
Keywords
Bladder cancer, Ta bladder tumors, TURBT, residual tumor, recurrence, NMIBC
Abstract
Background: Bladder cancer is one of the most frequently diagnosed malignancies of the urinary tract, with non-muscle invasive bladder cancer (NMIBC) constituting nearly 75% of all cases. Among these, Ta bladder tumors represent a subset confined to the urothelium without lamina propria invasion. While transurethral resection of bladder tumor (TURBT) is the primary diagnostic and therapeutic modality, studies indicate a substantial risk of residual tumor presence after initial resection. Re-TURBT (repeat TURBT) has been advocated to ensure complete tumor removal, improve staging accuracy, and reduce recurrence rates. However, its necessity in Ta tumors remains a topic of debate, particularly in resource-limited settings.
Aim: This study aims to evaluate the role of re-TURBT in Ta bladder tumors at Hamdard Institute Of Medical Sciences, New Delhi , by analyzing its impact on residual tumor detection, pathological upstaging, recurrence rates, and treatment modifications.
Methods: A prospective study was conducted in the department of surgery at Hamdard Institute Of Medical Sciences, New Delhi from Dec 2023 to Jan 2025. A total of 120 patients with newly diagnosed Ta bladder tumors were included. All patients underwent an initial TURBT, followed by a scheduled re-TURBT within 4–6 weeks. Histopathological outcomes, presence of residual disease, upstaging rates, and recurrence patterns were analyzed. Statistical analysis was performed using SPSS software, with p-values <0.05 considered significant.
Results: Re-TURBT identified residual tumor in 38% of cases, with 12% demonstrating pathological upstaging to T1. The recurrence rate at 12 months was 24% in the re-TURBT group compared to 41% in patients who did not undergo repeat resection. No significant increase in perioperative complications was noted. These findings suggest that re-TURBT contributes to better disease control and risk stratification in Ta bladder tumors.
Conclusion: Re-TURBT plays a crucial role in the management of Ta bladder tumors, significantly reducing recurrence and enabling more accurate staging. These results support the integration of re-TURBT into routine NMIBC management, particularly in cases with high-risk features. Further long-term studies are needed to assess its impact on overall survival and disease progression.
Aim: This study aims to evaluate the role of re-TURBT in Ta bladder tumors at Hamdard Institute Of Medical Sciences, New Delhi , by analyzing its impact on residual tumor detection, pathological upstaging, recurrence rates, and treatment modifications.
Methods: A prospective study was conducted in the department of surgery at Hamdard Institute Of Medical Sciences, New Delhi from Dec 2023 to Jan 2025. A total of 120 patients with newly diagnosed Ta bladder tumors were included. All patients underwent an initial TURBT, followed by a scheduled re-TURBT within 4–6 weeks. Histopathological outcomes, presence of residual disease, upstaging rates, and recurrence patterns were analyzed. Statistical analysis was performed using SPSS software, with p-values <0.05 considered significant.
Results: Re-TURBT identified residual tumor in 38% of cases, with 12% demonstrating pathological upstaging to T1. The recurrence rate at 12 months was 24% in the re-TURBT group compared to 41% in patients who did not undergo repeat resection. No significant increase in perioperative complications was noted. These findings suggest that re-TURBT contributes to better disease control and risk stratification in Ta bladder tumors.
Conclusion: Re-TURBT plays a crucial role in the management of Ta bladder tumors, significantly reducing recurrence and enabling more accurate staging. These results support the integration of re-TURBT into routine NMIBC management, particularly in cases with high-risk features. Further long-term studies are needed to assess its impact on overall survival and disease progression.
References
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10. Herr HW, Donat SM, Dalbagni G. Can restaging transurethral resection of bladder tumor reduce the need for early cystectomy in patients with T1 bladder cancer? Journal of Urology 2007; 177(1):70-75.
11. Palou J, Rodríguez-Rubio F, Huguet J, Segarra J, Ribal MJ, Alcaraz A, et al. “Multivariate analysis of clinical parameters of patients with T1 and Ta bladder tumors treated with Bacillus Calmette-Guérin: An update.” European Urology 2003; 44(4): 549-554.
12. Herr HW. “The value of a second transurethral resection in evaluating patients with bladder cancer.” Journal of Urology 1999; 162(1): 74-76.
13. Brausi M, Collette L, Kurth K, van der Meijden A, Oosterlinck W, Sylvester R, et al. “Variability of the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: A combined analysis of 2410 patients.” European Urology 2002; 41(5): 523-531.
14. Mariappan P, Smith G, Lamb AD, Grigor KM, Tolley DA. “Pattern of recurrence and stage progression in superficial bladder cancer: 17-year experience of a single center.” Urology 2005; 65(4): 703-708.
15. Orsola A, Cecchini L, Raventós CX, Trilla E, Planas J, Landolfi S, et al. “Risk factors for positive findings in second transurethral resection of stage T1 bladder cancer." Journal of Urology 2005; 173(1): 70-74.
16. Divrik RT, Sahin AF, Yildirim Ü, Zorlu F, Ozen H. “Impact of repeat transurethral resection on the long-term outcome of patients with newly diagnosed pT1 tumors.” Journal of Urology 2006; 175(4): 1641-1644.
17. Herr HW. “Role of repeat resection in non-muscle-invasive bladder cancer.” Journal of Urology 2015; 193(3): 829-830.
18. Gontero P, Sylvester R, Pisano F, Joniau S, Van Der Heijden AG, Witjes JA, et al. “The impact of re-transurethral resection on clinical outcomes in a large, multicentre cohort of patients with T1 bladder cancer.” European Urology 2016; 69(5): 1005-1012.
19. Dalbagni G, Herr HW, Reuter VE, Cordon-Cardo C. “Impact of a second transurethral resection on the staging of T1 bladder cancer.” Journal of Urology 2002; 168(4): 1080-1084.
20. Cambier S, Sylvester RJ, Collette L, Gontero P, Brausi MA, van Andel G, et al. “EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non–muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1–3 years of maintenance Bacillus Calmette-Guérin.” European Urology 2016; 69(1): 60-69.
21. Shelley MD, Mason MD, Kynaston H. “Intravesical therapy for superficial bladder cancer: A systematic review of randomized trials and meta-analyses.” Cancer Treatment Reviews 2010; 36(3): 195-205.
22. Sylvester RJ, van der Meijden AP, Oosterlinck W. “Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: A combined analysis of 2596 patients from seven EORTC trials.” European Urology 2006; 49(3): 466-477.
23. Grimm MO, Steinhoff C, Simon X, Spiegelhalder P, Ackermann R, Vogeli TA. “Effect of routine repeat transurethral resection for superficial bladder cancer: A long-term observational study.” Journal of Urology 2003; 170(2): 433-437.
24. Jocham D, Stepp H, Waidelich R. “Photodynamic diagnosis in early bladder cancer: A review of the evidence.” European Urology 2008; 53(6): 1138-1148.
2. Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J, van Rhijn BW, Rouprêt M, Shariat SF, Sylvester RJ, Zigeuner R. European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and CIS). European Urology 2019; 76(5):639-657.
3. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K. Predicting recurrence and progression in individual patients with stage TaT1 bladder cancer using EORTC risk tables. European Urology 2006; 49(3):466-475.
4. Mariappan P, Zachou A, Grigor KM. Ongoing inadequacy of transurethral resection of bladder tumors. Journal of Urology 2010; 184(2):463-468.
5. Palou J, Rodríguez-Rubio F, Huguet J, Segarra J, Ribal MJ, Alcaraz A, Villavicencio H. Multivariate analysis of clinical parameters of synchronous primary superficial bladder cancer. Journal of Urology 2003; 170(4):1389-1393.
6. Schwaibold H, Treiber U, Kubler H, Romer A, Felsenberg S, Hohenfellner R. Re-TUR in T1 transitional cell carcinoma of the bladder: significance and therapeutic consequences. European Urology 2000; 37(6): 623-627.
7. Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, Newling DW, Bouffioux C, Sylvester RJ. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage TaT1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. European Urology 2002; 41(5):523-531.
8. Dalbagni G, Herr HW, Reuter VE. Impact of a second transurethral resection on the staging of T1 bladder cancer. Urology 2002; 60(5):822-825.
9. Herr HW. Role of re-resection in non-muscle-invasive bladder cancer. Scientific World Journal 2011; 11:283-288.
10. Herr HW, Donat SM, Dalbagni G. Can restaging transurethral resection of bladder tumor reduce the need for early cystectomy in patients with T1 bladder cancer? Journal of Urology 2007; 177(1):70-75.
11. Palou J, Rodríguez-Rubio F, Huguet J, Segarra J, Ribal MJ, Alcaraz A, et al. “Multivariate analysis of clinical parameters of patients with T1 and Ta bladder tumors treated with Bacillus Calmette-Guérin: An update.” European Urology 2003; 44(4): 549-554.
12. Herr HW. “The value of a second transurethral resection in evaluating patients with bladder cancer.” Journal of Urology 1999; 162(1): 74-76.
13. Brausi M, Collette L, Kurth K, van der Meijden A, Oosterlinck W, Sylvester R, et al. “Variability of the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: A combined analysis of 2410 patients.” European Urology 2002; 41(5): 523-531.
14. Mariappan P, Smith G, Lamb AD, Grigor KM, Tolley DA. “Pattern of recurrence and stage progression in superficial bladder cancer: 17-year experience of a single center.” Urology 2005; 65(4): 703-708.
15. Orsola A, Cecchini L, Raventós CX, Trilla E, Planas J, Landolfi S, et al. “Risk factors for positive findings in second transurethral resection of stage T1 bladder cancer." Journal of Urology 2005; 173(1): 70-74.
16. Divrik RT, Sahin AF, Yildirim Ü, Zorlu F, Ozen H. “Impact of repeat transurethral resection on the long-term outcome of patients with newly diagnosed pT1 tumors.” Journal of Urology 2006; 175(4): 1641-1644.
17. Herr HW. “Role of repeat resection in non-muscle-invasive bladder cancer.” Journal of Urology 2015; 193(3): 829-830.
18. Gontero P, Sylvester R, Pisano F, Joniau S, Van Der Heijden AG, Witjes JA, et al. “The impact of re-transurethral resection on clinical outcomes in a large, multicentre cohort of patients with T1 bladder cancer.” European Urology 2016; 69(5): 1005-1012.
19. Dalbagni G, Herr HW, Reuter VE, Cordon-Cardo C. “Impact of a second transurethral resection on the staging of T1 bladder cancer.” Journal of Urology 2002; 168(4): 1080-1084.
20. Cambier S, Sylvester RJ, Collette L, Gontero P, Brausi MA, van Andel G, et al. “EORTC nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non–muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1–3 years of maintenance Bacillus Calmette-Guérin.” European Urology 2016; 69(1): 60-69.
21. Shelley MD, Mason MD, Kynaston H. “Intravesical therapy for superficial bladder cancer: A systematic review of randomized trials and meta-analyses.” Cancer Treatment Reviews 2010; 36(3): 195-205.
22. Sylvester RJ, van der Meijden AP, Oosterlinck W. “Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: A combined analysis of 2596 patients from seven EORTC trials.” European Urology 2006; 49(3): 466-477.
23. Grimm MO, Steinhoff C, Simon X, Spiegelhalder P, Ackermann R, Vogeli TA. “Effect of routine repeat transurethral resection for superficial bladder cancer: A long-term observational study.” Journal of Urology 2003; 170(2): 433-437.
24. Jocham D, Stepp H, Waidelich R. “Photodynamic diagnosis in early bladder cancer: A review of the evidence.” European Urology 2008; 53(6): 1138-1148.
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Published
Feb 20, 2025
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How to Cite
Dr. Yasir Iqbal Lone, Dr. Akansha Jain, Dr. Khushbu Girdher, & Dr. Annam Qayoom. (2025). ROLE OF RETURBT IN TA BLADDER TUMOURS OUR EXPERIENCE IN TERTIARY HEALTH CARE. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1146-1153. https://doi.org/10.53555/5wwrkc44
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Author Biographies
Dr. Yasir Iqbal Lone
Assistant professor, Department of urology, HIMSR, New Delhi, India.
Dr. Akansha Jain
Post graduate scholar, Department General surgery, MIMSR, New Delhi, India.
Dr. Khushbu Girdher
Senior Resident, Department of Pathology, HIMSR, New Delhi, India.
Dr. Annam Qayoom
Senior Resident, Department of Anaesthesia, HIMSR, New Delhi, India.
How to Cite
Dr. Yasir Iqbal Lone, Dr. Akansha Jain, Dr. Khushbu Girdher, & Dr. Annam Qayoom. (2025). ROLE OF RETURBT IN TA BLADDER TUMOURS OUR EXPERIENCE IN TERTIARY HEALTH CARE. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1146-1153. https://doi.org/10.53555/5wwrkc44