Saouli A, Zerda I, Elkhader K, Durand X, Ariane M, Quhal Fahad, Shammari Masoud Al, Contieri Roberto, Chebbi Ala
Department of Urology, Centre Hospitalier Régional Moulay Youssef, Rabat, Morocco.
Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco.
World J Urol. 2025 Jan 30;43(1):95. doi: 10.1007/s00345-025-05473-z.
This systematic review was conducted to synthesize current research on the role of repeated transurethral resection of the bladder (re-TURB) and the emerging use of magnetic resonance imaging (MRI) in discerning patient suitability for safely foregoing this procedure.
Employing a methodical literature search, we consulted several bibliographic databases including PubMed, Science Direct, Scopus, and Embase. The review process adhered strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines.
We evaluated data from 667 patients (mean age 65.8 years; age range 59-75 years) who underwent MRI prior to potential re-TURB. The gap between initial TURB and MRI was reported as 42 days in one study, while the interval between MRI and subsequent cystoscopy, with or without biopsy, varied from 21 days to 3 months. Initial TURB pathology for non-muscle invasive bladder cancer (NMIBC) patients identified stage Ta in 177 (42.5%) and T1 in 246 (57.5%) patients across three studies. High-grade and low-grade pathologic classifications were reported in 377 (64.5%) and 207 (35.5%) patients respectively in two studies. The VI-RADS scoring system's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of bladder cancer recurrence were 89%, 85.5%, 82.7%, and 96%, respectively. A total of 365 patients (54.7%) underwent re-TUR. Among NMIBC patients, re-TUR pathology revealed Ta in 22 cases (5.4%) and pT1 in 179 cases (44%) with VI-RADS 1-2, while no cases of Ta (0%) and 37 cases of T1 (9%) were reported with VI-RADS 4-5, as documented in two studies. Notably, only 69 patients (10.7%) were identified as having MIBC across all studies.
MRI is demonstrating reliability as a diagnostic tool for non-muscle invasive bladder cancers. The VI-RADS scoring system appears to be a promising approach in selecting patients for re-TURB. DW-MRI may serve as a primary diagnostic examination for patient follow-up post-TURB.
进行这项系统评价，以综合当前关于重复经尿道膀胱肿瘤电切术（re-TURB）的作用以及磁共振成像（MRI）在识别患者是否适合安全地避免该手术方面的新兴应用的研究。
我们采用系统的文献检索方法，查阅了多个文献数据库，包括PubMed、Science Direct、Scopus和Embase。综述过程严格遵循系统评价和Meta分析的首选报告项目（PRISMA 2020）指南。
我们评估了667例患者（平均年龄65.8岁；年龄范围59 - 75岁）的数据，这些患者在可能进行re-TURB之前接受了MRI检查。一项研究报告初始TURB与MRI之间的间隔为42天，而MRI与随后的膀胱镜检查（无论是否活检）之间的间隔从21天到3个月不等。三项研究中，非肌层浸润性膀胱癌（NMIBC）患者的初始TURB病理显示，Ta期患者有177例（42.5%），T1期患者有246例（57.5%）。两项研究分别报告了377例（64.5%）患者的高级别病理分类和207例（35.5%）患者的低级别病理分类。VI-RADS评分系统检测膀胱癌复发的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为89%、85.5%、82.7%和96%。共有365例患者（54.7%）接受了re-TUR。在NMIBC患者中，两项研究记录显示，VI-RADS 1 - 2级的患者re-TUR病理显示Ta期22例（5.4%），pT1期179例（44%），而VI-RADS 4 - 5级的患者未报告Ta期病例（0%），T1期病例37例（9%）。值得注意的是，所有研究中仅69例患者（10.7%）被确定为患有肌层浸润性膀胱癌（MIBC）。
MRI作为非肌层浸润性膀胱癌的诊断工具正显示出可靠性。VI-RADS评分系统似乎是选择进行re-TURB患者的一种有前景的方法。扩散加权磁共振成像（DW-MRI）可作为TURB术后患者随访的主要诊断检查。
