The Role of Restage Transurethral Resection of Urinary Bladder Tumor in Patients with High-Risk Non- Muscle Invasive Bladder Cancer-Our Experience in Mugda Medical College Hospital, Dhaka, Bangladesh

Author(s): Mohammod Mamunur Rashid, Muhammad Mahmud Alam, Mahmud Hasan, Khondaker Arafuzzaman, Shariful Islam Khan, Mohammad Al Amin, Arifur Rahman KM, Makter Alam

Background: Transurethral resection of bladder tumor (TURBT) is the cornerstone for diagnosis and initial management of non-muscle invasive bladder cancer (NMIBC). However, in high-risk NMIBC, a significant proportion of patients harbor residual tumor or are under-staged following initial TURBT. Restage TURBT (re-TURBT) has been recommended to improve diagnostic accuracy and oncological outcomes.

Objective: To evaluate the role of re-TURBT in high-risk NMIBC patients and to share our institutional experience at Mugda Medical College Hospital.

Methods: This prospective observational study included 100 patients with high-risk NMIBC (Ta high-grade, T1, and/or carcinoma in situ) treated between January 2020 and December 2024. All patients underwent initial complete TURBT, followed by re-TURBT within 2–6 weeks. Residual tumor detection rate, tumor upstaging, recurrence, and complications were analyzed.

Results: Among 100 patients, 62% had residual tumor detected on re- TURBT. Tumor upstaging to muscle-invasive disease occurred in 14%. Residual tumor was most common in T1 high-grade lesions (71%). Re- TURBT led to change in management plan in 28% of cases (early radical cystectomy or intensified intravesical therapy). Perioperative morbidity was minimal, with no major complications.

Conclusion: Re-TURBT significantly improves staging accuracy and therapeutic planning in high-risk NMIBC. Our study supports the routine use of re-TURBT as a standard of care in high-risk cases to optimize longterm oncological outcomes.