Benefit of Repeat TUR (Transurethral Resection of Bladder Tumor) for High Risk Bladder Cancer

It is an established fact that for high-risk bladder cancer that includes T1 disease as well as high-grade Ta disease a repeat transurethral resection 3-6 weeks after the initial procedure detects additional disease and a significant number of patients and changes treatment plan leading to improves outcomes.

In fact American Urological Association recommends routine repeat TUR in all patients with high risk non-muscle invasive bladder cancer.

I can tell from experience few patients are excited about the prospect of undergoing another procedure.  However the benefits are clear and I routinely recommend it.

Some patients asked me whether  innovations including photodynamic therapy with 5-ALA may obviate the need for second resection. Photodynamic therapy with 5-ALA improves detection of bladder cancer that is not visible to the eye on the first resection.  Photodynamic  therapy can address part of the benefit achieved with a second resection.  But for patients with high risk disease repeat TUR will still be beneficial to restage the depth of the tumor which may not be completely resected initially in some patients.  Tumor restaging can totally change the course of treatment and subsequently its success.

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