A prospective observational study to evaluate the utility of restages transurethral resection of bladder tumor
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 8, Pages 5967-5974
AbstractAim: The aim of the present study to evaluate the utility of restages transurethral resection of bladder tumor.
Methods: This was a prospective observational study conducted in the Department of urology, IGIMS Patna, Bihar, India, for 1 year.
All patients with proven histological diagnosis of non-muscle invasive urothelial cancer with either high grade or T1 cancers on histopathology were enrolled. During initial cystoscopy, the operative details such as the number of lesions, solid or papillary configuration of lesions and the site of lesions were mapped and recorded. TURBT at our center was performed using a 26 Fr resectoscope and monopolar cautery. After complete TURBT, a deep biopsy from the base of the tumor was taken. The TURBT chips and the deep biopsy were sent separately. Restage TURBT was advised at 4–6 weeks from initial TURBT as per the EAU guidelines. The cystoscopic findings were recorded during the restage TURBT similar to that at the initial TURBT. In patients with no obvious tumors, resection of the tumor bed was performed and sent for analysis. The histopathology reports of all patients were recorded. Post restage, the patients were then managed by a standard treatment protocol and follow-up.
Results: 100 patients satisfied the inclusion criteria as per EAU guidelines for restage (T1 or high grade). 52 had T1 high grade, 48 patients had T1 low grade. A total of 100 patients underwent restage TURBT, 70 patients within 4–6 weeks, and 30 patients between 6 to 12 weeks of the initial TURBT. The mean age of the 100 patients was 54 years (range 18–79 years) and 20(20%) of them were females. Tumor was detected in 30 patients (30%) during restage TURBT, of which 25 patients had non invasive disease. The stage distribution after restage TURBT. Of these 25 patients, tumor was present at the same site in 22 patients (88%) and at different site in 3 patients (12%). All the tumors were <3 cm in size, 19 (76%) had single lesion and 6 patients (24%) had multiple growths. In 18 patients (72%) the recurrence was of same stage (T1), in 7 (28%) it was of lower stage (Ta) and stage up-migration to muscle invasive disease (T2) was found in 6 cases (24%).
Conclusion: The restage TURBT is necessary in patients with solid bladder tumors. The presence of tumor at restage confers a higher risk of recurrence and progression. Poor patient compliance for a restage TURBT remains a matter of concern.
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