EAU15: Point-Counterpoint Session: NMIBC- Is a second TUR necessary?

23 March 2015

Do better resection and better diagnosis achieved by reTUR (repeat transurethral resection) have clinical consequence?

This was one of the questions examined by discussant Marko Babjuk (CZ) during the Point-Counterpoint Session of Thematic Session 19 which tackled controversies in the management of bladder cancer. Babjuk took the pro arguments against Thierry Lebret (FR) who provided the opposing opinion.

To the query, Babjuk was clear: “Yes, it can reduce recurrence rate and improve indication of further treatment.”

But he posited a caveat, saying the main goal is “excellent initial resection.”

“The second TUR is a rescue procedure of unsuccessful initial TURB (transurethral resection of the bladder). And each institution should be aware of its own results (such as residual tumors, etc.),” Babjuk said.

He also mentioned the results of reTURs should be evaluated prospectively and more carefully with respect to prognostic factors.Babjuk then queried if surgeons can improve the quality of initial resection, to which he gave an affirmative reply. He added: “But the risk of tumour persistence and under-staging is still significant.”

Recapping his arguments, Babjuk said it is crucial that guidelines recommendations should be focused and critically discussed, and noted that most reTURs are triggered by unsuccessful initial procedures.

Lebret gave a spirited defense saying that reTUR can be a tricky or difficult procedure which can lead to complications such as bleeding, bladder perforation risk and diverticula, among others. Lebret also said the procedure is often performed by junior or less experienced urologists, a tendency that could be encouraged by the perception that the patient is not at risk and a re-resection is still possible.

“The initial resection is crucial,” Lebret stressed. In a tongue-in-cheek jest, he added: “There are two French proverbs, ‘Something that has to be done must be well done. And performing a bladder resection is like making love- take your time, control the bleeding, enjoy the procedure and control the nerve reflex. “To which the audience responded with laughter and a warm applause.