The value of a second transurethral resection in evaluating patients with bladder tumours

Objectives: To evaluate the usefulness of a second transurethral resection for superficial and muscle-invasive bladder tumours. Methods: A review of the literature relevant to repeat resection for bladder tumours was conducted using Medline Services. Results: Transurethral resection of the bladder has two shortcomings: underestimating clinical stage, and overlooking other lesions. A second transurethral resection, when performed 2-6 weeks after the initial resection, corrects clinical staging errors in 9-49% of cases and detects residual tumour in 26-83% of cases. A second resection is particularly warranted for T1 tumours since 2-28% of them prove to be muscle-invasive, thus requiring a change in management. For muscle-invasive tumours, a second resection may be performed only if bladder sparing is being considered, as it helps to exclude the presence of tumour sites contra-indicating conservative treatment. Conclusions: A second transurethral bladder resection may be warranted for T1 tumours, and for invasive tumours when a bladder preservation is planned. (C) 2003 Elsevier Science B.V. All rights reserved.