Two-step transurethral resection of bladder tumor improves surgical quality and decreases disease recurrence: a retrospective study

Abstract Background: Two-step transurethral resection of bladder tumor (TURBT) is a method of TURBT that is performed in two steps- exophytic tumors first and tumor bases second. The purpose is to improve tumor clearance. In current study, we evaluated outcomes of two-step TURBT in patients with non-muscle invasive bladder cancer (NMIBC). Methods: We retrospectively reviewed a prospective database. Patients who had newly diagnosed NMIBC with at least a 2-year follow-up period during Jan. 1, 2012 and Dec. 31, 2017 were enrolled. Patients with concomitant or subsequent upper urinary tract urothelial carcinoma (UTUC) were excluded. Patients were categorized into the two-step TURBT (TR) group and the conventional TURBT (CR) group. The primary endpoints were the recurrence rate and the progression rate. The secondary endpoints were the recurrence-free survival (RFS), the progression-free survival (PFS), and the detrusor muscle sampling rate. Results: A total of 205 patients were included, with 151 patients in the TR group and 54 patients in the CR group. The median follow-up period was 40.5 months. There were lower recurrence rate (29.8% vs 48.1%, P = 0.015), higher detrusor muscle sampling rate (70.7% vs 55.6%, P = 0.043), and longer RFS ( P= 0.007) in the TR group. TR was also associated with longer RFS in both univariate (HR=0.524, p =0.009) and multivariate (HR=0.426, p =0.003) analysis. Conclusions: Two-step TURBT results in lower recurrence rate and longer RFS for NMIBC, especially for Ta disease. Two-step TURBT also improves detrusor muscle sampling rate, which is essential for adequate resection and accurate staging.