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ROLE OF RESTAGING TRANSURETHRAL RESECTION OF BLADDER TUMOR IN PATHOLOGICAL UPSTAGING OF NON-MUSCLE INVASIVE HIGH-GRADE UROTHELIAL BLADDER TUMORS. OUR INSTITUTE EXPERIENCE

Background: Transurethral resection of supercial bladder tumours is well known to be gold standard management. It is
evident from the literature that initial TURBT is not enough for accurate pathological staging in non-muscle invasive
bladder cancer.
Aim: Our study is aimed at role of restaging TURBT in detection of residual disease for pathological upstaging in these high-risk patients to plan
appropriate treatment.
Methods: This is a prospective study of 32 patients with initially diagnosed Ta/T1 high-grade bladder cancer who had restaging TURBT in a
study by Department of urology, NIMS, Hyderabad between January 2016 and December 2018 were included. Low-grade tumors, carcinoma in
situ and muscle invasive bladder tumors were excluded. Data elements collected on patient demographics, presence of residual disease, disease
progression and recurrence in the follow-up period. The data was statistically analyzed using descriptive statistics by SPSS version
17. P value <=0.05 is considered as statistically signicant.
Results: The mean age for patients included in the study was 60.5 years. In our study, we found that 15 out of 32 cases (47%) has been detected
with residual disease ensuring that single TURBT may not been efcient with complete removal of tumor. Six out of 32 cases (19%) had
upstaging and 5 out of 32 cases had concurrent carcinoma in situ leading to change in treatment. Therefore, 11 out of 32 cases (34%) has been
under staged by initial TURBT were adequately staged by restaging TURBT and subjected to radical cystoprostatectomy or chemo radiotherapy,
This mandates the need for restaging TURBT at 6-8 weeks interval for adequate staging and management. Upstaging on restaging TURBT was
seen in 19%. The progression-free survival rate at 16 months was 25 % in patients with residual tumour and 94% in cases without residual disease.
Conclusion: We conclude that restaging TURBT effectively detects residual disease, helping pathological upstaging and planning denitive
treatment in non-muscle invasive high-grade bladder tumour.