Repeated transurethral resection and intravesical BCG for extensive superficial bladder tumors

Purpose: We report our experience with repeat transurethral resection (TUR) in a group of patients with superficial bladder tumors in whom complete re section in one session was impossible because of the extensive tumor burden . Patients and Methods: Only the patients with such extensive (> 10 g of rese cted tissue) tumors that we were unable to perform complete TUR initially w ere included in the present study. The patients underwent repeat TUR(s) 4 w eeks after the previous one until complete resection of the tumor was achie ved. After complete TUR, if the pathology examination confirmed superficial disease, the patients received intracavitery immunotherapy and were follow ed up thereafter. If pathology examination documented muscle-invasive disea se, cystectomy was suggested. Results: Of the 43 patients undergoing repeat TUR, 15 needed a second and 5 needed a third session to achieve complete resection. Of the patients, 28 (65%) had stage T, and 15 (35%) has stage T. tumor. Eight patients (19%) ot herwise regarded as having superficial tumor were found to have muscle-inva sive disease following repeat TURs. The mean follow-up of the remaining 35 patients with superficial disease was 34 months (range 1-126 months). Four of the patients with superficial disease progressed to T-2 tumor. However, 16 patients achieved a state of complete response with no tumor recurrences during a mean of 38 months (range 4-126 month). The present protocol achie ved bladder sparing in a total of 22 (63%) of the 35 patients with superfic ial disease. Conclusions: From the presented series, we suggest that one can use the com bination of repeat TUR and intravesical immunotherapy in the management of bulky superficial bladder tumors in an effort to preserve the bladder.