Effect of Repeat Transurethral Resection to Bacillus Calmette-Guerin Therapy in High-Grade T1 Non-Muscle Invasive Bladder Cancer

Background: Standard treatment of high-risk non-muscle-invasive bladder cancer (NMIBC) consists of transurethral resection of bladder tumor (TURBT) with the addition of intravesical Bacillus Calmette-Guerin (BCG). Despite this standard treatment, patients with NMIBC are experiencing recurrence and progression. To reduce the failure rate of BCG therapy, repeat transurethral resection (TUR) has emerged as a new standard of care for high-risk NMIBC approved by different guidelines.

Aim of the Study: The study aimed to compare the findings of repeat and no-repeat transurethral resection to Bacillus Calmette-Guerin therapy in high grade T1 non-muscle-invasive bladder cancer. Methods: This comparative study was conducted in the Department of Urology, Dhaka Medical College Hospital Dhaka, Bangladesh, from August 2018 to January 2020. A total of 40 patients with T1 bladder cancer fulfilled the selection criteria. Patients were divided into two groups. In the repeat TUR group (Group A), there were 20 patients, and in the no-repeat TUR group (Group B), there were other 20 patients. All the patients of both groups received induction of intravesical BCG therapy All the patients were followed up with predefined schedule.

Results: Among 20 patients of Group A, the residual tumor was found in 35% of patients at 6 weeks, and there was no upstaging at 6 weeks. Recurrence between two groups was statistically significant at 3, 6, 9, and 12 months follow up (p <0.05). Total recurrence was detected in 20% of the patients in Group A and 70% in Group B at 12 months of follow-up. The most frequent recurrence was seen at 3 months in patients with Group B, which was 5 times higher than Group A. In Group A and Group B, disease progression seen at 12 months follow-up was 5% and 20%, respectively, p<0.001.

Conclusion: Repeat-transurethral resection improves the initial response to BCG therapy by significantly decreasing the recurrence rate and progression in patients with high-grade T1 TCC of the urinary bladder.