Reassessing re-TURBT in the modern era: Is it time to move from routine to selective?

This work aimed to determine the pathological yield of restaging transurethral resection of bladder tumour (re-TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) managed at a contemporary tertiary-care setting and to describe clinicopathological features among patients with positive restaging histopathology to select patients most likely to benefit from re-TURBT.

This single-centre retrospective observational case-control analysis within a re-TURBT cohort included patients who underwent macroscopically complete index TURBT for presumed NMIBC and subsequently underwent restaging TURBT within the institutional pathway. Patients with muscle-invasive disease at index TURBT, benign pathology, non-urothelial carcinoma, variant histology, or ineligibility for re-TURBT for any reason were excluded. The primary outcome was positive restaging histopathology, defined as residual urothelial neoplasia or pathological progression. In addition, clinicopathological variables were explored to identify factors potentially associated with positive re-TURBT, including tumour size, multifocality, age, sex, tumour grade, detrusor muscle status, and carcinoma in situ on index histopathology.

Among 188 TURBT records assessed, 79 patients underwent re-TURBT and formed the analysed cohort. Median age was 64 years (IQR 56-69), 69 patients (87.3%) were male, and detrusor muscle was present in 77 index specimens (97.5%). Positive restaging histopathology occurred in nine patients (11.4%), comprising residual disease in eight (10.1%) and Ta high-grade to T1 high-grade progression in one (1.3%); no muscle-invasive upstaging was observed. In the T1-only analysis, positivity occurred in 8/69 (11.6%). Larger tumours, multifocality and CIS were more frequent among positive cases. Follow-up recurrence admission occurred in 9 patients (11.4%).

In this contemporary re-TURBT series, the pathological yield of restaging was low, with uncommon progression. Positivity clustered in those with larger tumours (≥3 cm) and high-risk biology (multifocal disease and carcinoma in situ on index histopathology). These findings are hypothesis-generating and support prospective evaluation of selective restaging strategies in the contemporary era.