Editorial comment

Abstract

Clinical staging, as determined by examination under anesthesia and TURBT, dictates the management of bladder cancer. A superficial (Ta) or superficially invasive (T1) transitional cell carcinoma will be managed endoscopically, and muscle-invasive tumors will require radical cystectomy. However, clinical staging has its limitations, with a rate of understaging of 30% for T1 tumors, even in the best of hands. 1 Thrasher J.B Frazier H.A Robertson J.E et al. Does stage pT0 cystectomy specimen confer a survival advantage in patients with minimally invasive bladder cancer?. J Urol. 1994; 152: 393-396 Google Scholar , 2 Pagano F Bassi P Galetti T.P et al. Results of contemporary radical cystectomy for invasive bladder cancer a clinicopathological study with an emphasis on the inadequacy of the Tumor, Nodes and Metastases classification. J Urol. 1991; 145: 45-50 Abstract Full Text PDF Scopus (351) Google Scholar A second TURBT has been advocated to decrease the understaging error in patients with tumor involving the lamina propria. Residual bladder tumor has been detected in 76% of patients subjected to a restaging TURBT, with 49% having muscle-invasive tumor in the second resection if no muscle was present in the original TURBT. 3 Herr H.W The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol. 1999; 162: 74-76 Abstract Full Text Full Text PDF Scopus (407) Google Scholar Furthermore, a second TURBT has resulted in better staging, as indicated by an 11% understaging error in patients with Stage T1 who underwent two TURBTs immediately before undergoing cystectomy. 4 Dalbagni G Herr H.W Reuter V.E Impact of a second transurethral resection on the staging of T1 bladder cancer. Urology. 2002; 60: 822-825 Abstract Full Text Full Text PDF Scopus (96) Google Scholar