# Restage Transurethral Resection in the Evaluation of T1 High-Grade Bladder Tumor

## TL;DR

Restaging transurethral resection helps detect residual or more advanced bladder cancer in patients with high-grade T1 tumors, improving treatment planning.

## Contribution

The study demonstrates the clinical value of restaging TURBT in T1 high-grade bladder tumors for accurate staging and management.

## Key findings

- Restaging TURBT detected residual tumors in 58.5% of patients.
- Nine point eight percent of patients were upstaged from T1 to T2 after restaging.
- Larger tumor size and multiple tumors were linked to residual disease.

## Abstract

Background: A considerable proportion of patients with T1 high-grade non-muscle invasive bladder cancer (NMIBC) advance to muscle-invasive disease, and the disease has a high rate of recurrence. Numerous approaches have been proposed in the literature to mitigate the consequences of the initial transurethral resection of bladder tumors (TURBT). We aimed to evaluate the T1 high-grade bladder tumor by restaging transurethral resection.

Methods: This was a descriptive observational study conducted in the Department of Urology, Sylhet MAG Osmani Medical College Hospital, Sylhet, from August 2023 to March 2024. A total of 41 patients with T1 high-grade urinary bladder tumors with the presence of a muscle layer in histopathology specimens were included in this study. Their demographic details, prior cystoscopy results, and histopathology reports were documented. A restaging TURBT was performed 2-6 weeks after the initial TURBT to reassess the T1 high-grade bladder tumor, focusing on the detection of any residual pathology.

Results: The study included 41 patients, mostly male (92.7%), with a mean age of 64.6 ± 6.6 years. After restaging, 41.5% (17 patients) had no residual tumor, while 58.5% (24 patients) had residual tumor. Of those with residual tumor, 20 (48.8%) remained T1, and 4 (9.8%) were upstaged to T2. The majority had high-grade tumors (51.2%, 21 patients). Residual tumor was associated with a higher incidence of tumor size >3 cm (16.0% vs. 6.3%) and multiple tumors (16.0% vs. 0.0%).

Conclusion: Restaging transurethral resection of a T1 high-grade bladder tumor detects residual tumor and upstaging of disease, which remains crucial for staging purposes and subsequent therapeutic effect.