Repeat TURBT for Ta and T1 bladder cancer: An updated review

The objective of this study is to determine residual tumor characteristics for high grade Ta and T1 bladder tumors following transurethral resection of bladder tumor (TURBT) at a facility where initial aggressive resection is standard.

This is a retrospective review of patients who had multiple TURBTs done by 2 urologic oncologists at a single facility. During a 5-year period from 2018 to 2022 using specific ICD-10 and CPT codes, the institutional electronic health record was used to identify patients requiring repeat resection for high grade Ta and all T1 bladder cancer. Data compilation and statistical analysis was performed on points of interest from initial to repeat resection, most notably, tumor upstaging and tumor persistence while accounting for multiple demographic variables.

Analysis of our institutional data indicates 143 patients who underwent an initial and repeat TURBT at our facility during the 5-year period of interest. Retrospective data demonstrates a tumor persistence rate of 27.7% and 34.6% for Ta and T1 bladder cancer, respectively. Additionally, our data reveals an upstaging rate of only 3.1% and 3.8% for Ta and T1 bladder cancer, respectively.

Per current American Urological Association (AUA) guidelines, patients with T1 or high-grade Ta bladder cancer should undergo repeat transurethral resection within 6 weeks as previously published literature reports high rates of tumor upstaging and progression. Our data shows a dramatically lower rate of tumor persistence and tumor upstaging on repeat TURBT compared to historical literature, and our surgical approach could potentially challenge the need for repeat resection for certain patients.