Syed Saleem Abbas Jafri, Zafar Iqbal Khan Niazi, Muhammad Saleem Akhtar.
The Clinical Value of Immediate Second Transurethral Resection in patients with High Grade Non-Muscle Inasive Bladder Cancer (HG-NMIBC).
Annals Punjab Med Coll Jan ;9(4):174-9.

Objectives: This study was designed to estimate the value of a second transurethral resection of bladder tumor in patients with initially diagnosed T1 High-grade bladder cancer. Material & Methods: Between October 2008 and November 2015, a total of 350 patients were diagnosed with T1 high grade non-muscle invasive bladder cancer. These patients were divided into two groups. Group A: 150 patients who underwent an early re-resection. Group B: 200 patients who did not undergo early re-resection. Data were collected retrospectively which included patient’s history, physical examination, and investigation, histological parameters including presence of detrusor muscle at initial TUR and at second TUR, recurrences and progression rates. Results: The detrusor muscle was present in 90 patients out of 150 patients (60%) in Group A and in 158 patients out of 200 patients (79%) in Group B, at initial TUR. At early re-resection, detrusor muscles were present in 76.67% of patients. The residual tumor was present in 55% of re-resected patients. The overall incidence of tumor recurrence was 34.66% and 42% in Groups A and B, respectively. There was a significantly higher rate of tumor progression in patients who did not undergo early re-resection during follow up. (Group 14.28% v. s. Group 3.85% P<0.05). Conclusion: A second TUR should be routinely advised in all patients with T1 high grade bladder cancer, to achieve a complete resection and to identify patients who may need to undergo radical cystectomy.

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