When to Avoid a Restaging Procedure for Non-muscle Invasive Bladder Cancer? Inferences from a Tertiary Care Center

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Urinary bladder carcinoma incidence is rising, with 70% being non-muscle invasive bladder cancer (NMIBC).
• Restage transurethral resection of bladder tumor (TURBT) is recommended for accurate staging of T1 and high-grade NMIBC.
• The necessity and patient impact of restage TURBT remain subjects of debate.

Purpose of the Study:

• To evaluate the oncological outcomes of NMIBC patients undergoing restage TURBT.
• To identify preoperative factors predicting tumor upstaging or recurrence after initial TURBT.
• To determine if restage TURBT can be safely omitted in certain NMIBC patient subgroups.

Main Methods:

• Prospective observational study of 72 NMIBC patients from September 2018 to February 2020.
• Data collection included demographics, imaging, cystoscopy, and histopathology.
• Analysis of clinico-pathological correlations and prediction of recurrence and upstaging.

Main Results:

• Twelve patients (16.7%) experienced recurrence, and 3 (4.16%) were upstaged to T2 at restage TURBT.
• Lower urinary tract symptoms (LUTS) and chemical exposure were associated with recurrence risk.
• Preoperative CT lymphadenopathy was linked to an increased risk of upstaging.

Conclusions:

• Restage TURBT may be omitted if the initial TURBT was adequate and the patient lacks specific risk factors.
• Patients with preoperative lymphadenopathy, chemical exposure history, or LUTS may require restage TURBT for accurate staging.
• Further large-scale studies are needed to validate these findings and refine management strategies.