Department of Urology, Suez Canal University Hospital, Ismailia, Egypt.
J Endourol. 2010 Dec;24(12):2047-50. doi: 10.1089/end.2010.0319. Epub 2010 Oct 8.
Evaluation of second-look transurethral resection (TUR) in avoidance of staging errors, and determination of risk factors of upstaging in patients with nonmuscle invasive bladder cancer.
An analytic prospective cohort study included 91 patients with stage T(1) and T(a) bladder cancer. All patients underwent second-look TUR within 2 to 6 weeks after the initial resection. Histopathologic findings of the second TUR of bladder tumor (TURBT) were compared with those of the initial one.
Specimens obtained during the second TURBT showed no tumor in 38 (41.7%) patients; 22 (24.2%) patients had residual cancer of the same stage, 9 (14.8%) patients of PT(1) had a lower stage, and 22 (24.2%) had a higher stage. Upstaging had changed treatment strategy in 22 (24.2%) cases. Appearance, size, grade, and stage of the tumor at the initial resection are all considered independent risk factors for upstaging detected at second-look TURBT.
Second TURBT is a valuable procedure for accurate staging of nonmuscle-invasive bladder cancer. It changed the treatment strategy of a significant proportion of our patients. Second TURBT is indicated in T(1), high grade, large size (>3 cm), and nodular tumors because of the significant risk of detecting muscle-invasive disease.
评估二次经尿道膀胱肿瘤切除术（TUR）以避免分期错误，并确定非肌层浸润性膀胱癌患者分期升级的危险因素。
一项分析性前瞻性队列研究纳入了 91 例 T1 和 Ta 期膀胱癌患者。所有患者均在初次切除后 2 至 6 周内行二次 TUR。将二次 TUR 膀胱肿瘤的组织病理学发现与初次 TUR 进行比较。
在二次 TURBT 中，38 例（41.7%）患者未发现肿瘤；22 例（24.2%）患者有相同分期的残留癌，9 例（14.8%）PT1 期患者降期，22 例（24.2%）患者升期。22 例（24.2%）患者的分期升级改变了治疗策略。初次切除时肿瘤的外观、大小、分级和分期均被认为是二次 TURBT 检测到分期升级的独立危险因素。
二次 TURBT 是一种准确分期非肌层浸润性膀胱癌的有价值的方法。它改变了我们患者中很大一部分的治疗策略。由于存在显著的肌层浸润性疾病检测风险，T1 期、高级别、大肿瘤（>3cm）和结节状肿瘤应行二次 TURBT。
