Repeat transurethral resection of bladder tumor (TURBT) prior to radical cystectomy does not improve survival in cT2N0 muscle-invasive bladder cancer, a new study concludes.

In a propensity-score matched analysis of 548 patients, recurrence-free and overall survival did not differ significantly between groups receiving and not receiving repeat TURBT before radical cystectomy, Neema Navai, MD, of the MD Anderson Cancer Center in Houston, Texas, and colleagues reported. The investigators matched patients by age, gender, receipt of neoadjuvant chemotherapy, preoperative hydronephrosis, variant histology, lymphovascular invasion, and carcinoma in situ.

The absence of residual tumor on repeat TURBT pathology was associated with improved recurrence-free and overall survival. However, the investigators found that more than 60% of patients with pT0 disease on repeat TURBT had residual disease on radical cystectomy pathology, including 18% with extravesical disease.

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According to Dr Navai’s team, “these data suggest that current clinical staging is an unreliable indicator of the extent of true residual disease.” This finding is important because support for bladder-sparing therapies are based on clinical staging.

“In the future, patient selection may move towards advanced molecular techniques, including genetic/genomic alterations in tumor tissue,” they noted.


Bree KK, Kokorovic A, Westerman ME, et al. Repeat transurethral resection of muscle-invasive bladder cancer prior to radical cystectomy is prognostic but not therapeutic. J Urol. Published October 11, 2022. doi:10.1097/JU.0000000000003015