Re-TURBT Redefined: How Repeat Transurethral Resection Optimizes Management of High-Grade Non-Muscle-Invasive Bladder Cancer

Background: High-grade non-muscle-invasive bladder cancer (HG-NMIBC) has a strong tendency to recur early, often because some tumor is left behind after the first resection rather than because a new tumor has formed. Systematic reviews report residual disease in 33–53% of patients after an initial transurethral resection of bladder tumor (TURBT). This prospective study evaluated how useful a repeat TURBT (reTURBT) is in high-grade T1 NMIBC — how often it finds residual tumor, how often it changes the stage, and which factors predict this. Material and Methods: This prospective study was done at the NCR Institute of Medical Sciences, Meerut (May 2025–May 2026). Thirty adults with confirmed high-grade T1 NMIBC underwent reTURBT 4–6 weeks after their first resection. Group comparisons used the chi-square test. Because some subgroups were small, we also calculated exact 95% confidence intervals (Clopper-Pearson method) so small-sample estimates are not over-interpreted. Results: Residual or recurrent tumor was found in 56.7% of patients (17/30; 95% CI 37.4–74.5%). Rates were highest in anterior wall tumors (100%, 3/3), tumors ≥3 cm (80%, 4/5), and multiple tumors (63.6%, 7/11) — though the anterior wall and size subgroups had very few patients, so their confidence intervals are wide (29.2–100% and 28.4–99.5%) and should be read with caution. Upstaging from T1 to T2 occurred in 6.6% of cases (2/30; 95% CI 0.8–22.1%). Whether or not detrusor muscle was present in the first specimen made no clear difference to recurrence (58.3% vs. 55.6%). Conclusion: ReTURBT identifies clinically significant residual disease and staging changes in high-grade T1 NMIBC and supports the EAU/AUA recommendation for routine re-resection in high-risk cases. Some of our subgroup findings are based on very small numbers and need confirmation in larger studies. A selective approach may be reasonable for lower-risk patients.

Keywords: Urinary Bladder Neoplasms, Neoplasm Staging, Reoperation, Cystoscopy.