Year: 2024 | Month: September | Volume: 14 | Issue: 9 | Pages: 173-178
DOI: https://doi.org/10.52403/ijhsr.20240922
The Impact of Re-Transurethral Resection for Non-Muscle Invasive Bladder Tumour
Amit Kumar Shah1, Mohamad Anish Ahamad2, Rupesh Kumar Jha1, Deepak Pun3, Bashu Dev Baskota3
1Urology Unit, Department of Surgery, B and C Medical College and Teaching Hospital Birtamod, Nepal
2Urology Unit, Department of Surgery, National Medical College and Teaching Hospital Birgunj, Nepal
3Department of Surgery, B and C Medical College and Teaching Hospital Birtamod, Nepal
Corresponding Author: Amit Kumar Shah
ABSTRACT
Urinary bladder cancer is a disease from indolent low-grade non-muscle invasive disease to muscle-invasive disease which has poor outcomes despite the treatment. There is an increasing trend of this disease in the developing countries like Nepal. Non-muscle invasive bladder carcinoma occupies almost seventy per cent of the cases. Re-transurethral resection of bladder tumour has been recommended by all the guidelines for Ta high-grade and T1 non-muscle invasive tumors for accurate staging and from the therapeutic aspect. However, the second procedure has difficulty like the patients’ concern about the completeness of the procedure, perioperative morbidity, and the financial burden involved in a major surgery which puts a strain on the already overburdened healthcare systems in developing countries. Several publications have raised the question and have advocated for the avoidance of a second procedure in today's era.
Aims and Objectives: To evaluate the potential impact of re-TURBT with comparison to the standard TURBT in high-grade NMIBC.
Method: The study was a retrospective analysis of a prospectively maintained database in which the first 98 patients were selected for the study. The criteria were set for those patients with a follow-up of a minimum of 6 months after the initial TUR to be included in the study. Patients who underwent an early resection (Group A) had 37 patients and those who did not (Group B) had 61 patients. Early resection was performed after two weeks of initial TUR and within six weeks of initial TUR.
Results: Detrusor muscle was present in 78.30% (n = 29) of patients in Group A and 83.60% (n = 51) of patients in Group B. Residual tumor was present in 48.64% (n =18) of re-resected cases. Among these residual tumour cases, 4 cases were found to be upgraded. The overall incidence of tumour recurrence was 38.23% and 83.60% in Groups A and B, respectively. Similarly, there was no tumour progression at the end of follow-up in group A, while in group B progression was seen in 10 patients (16.40%) concluding P-value significant P<0.001.
Conclusion: re-TURBT aids accurate staging and clearance of residual burden of the disease. Early resection is beneficial in decreasing the tumor recurrence and hence decreases the rate of tumour stage progression.
Key words: Bladder Cancer; re-TURBT; re-resection; non-muscle invasive bladder cancer; recurrence; restaging; progression; upgrading.