Is ‘second-look’ (re-staging) transurethral resection of bladder tumours a new standard of care?

Transurethral resection (TUR) is the essential surgical procedure used to diagnose, stage and treat nonmuscle-invasive (NMIBC) bladder tumours. TUR of bladder tumours is a diagnostic, prognostic and therapeutic operation. TUR aims to provide adequate specimen material to determine the histological type and grade of bladder tumours, to determine the presence and depth of tumour invasion, and to remove visible and microscopic superficial and invasive tumours. The findings are used to direct further therapy, dictate follow-up schedules, and indicate prognosis [1]. Although TUR is a common operation familiar to most urologists, it is a stochastic procedure subject to unquantifiable variables related to the surgeon, tumour and pathology; as a result, its diagnostic and therapeutic purposes are not always achieved. To overcome these limitations, a second-look, or re-resection 2–6 weeks after an initial TUR has been incorporated more frequently into clinical practice, especially for high-risk tumours. The European Association of Urology guidelines recommend a repeat TUR in all patients with stage T1 or high-grade tumours [2]. We believe a second-look TUR should be considered the new standard of care for high-risk NMIBC.