A 55-year-old man undergoes TURBT for a 3 cm papillary bladder tumour. Histology shows high-grade T1 urothelial carcinoma with lamina propria invasion but no muscularis propria in the specimen. What is the most appropriate next step?
- A Intravesical BCG maintenance therapy starting 2 weeks after TURBT
- B Repeat (restaging) TURBT within 4–6 weeks, then intravesical BCG if still T1 HG ✓
- C Radical cystectomy immediately
- D Surveillance cystoscopy at 3 months
Correct answer: B. Repeat (restaging) TURBT within 4–6 weeks, then intravesical BCG if still T1 HG
Explanation
When a T1 high-grade bladder tumour is resected without muscularis propria (detrusor) in the specimen, EAU guidelines mandate a restaging TURBT within 4–6 weeks to exclude upstaging to T2 and to achieve complete resection; muscle-invasive disease (T2+) changes management to radical cystectomy. If restaging confirms T1 HG, BCG induction followed by maintenance is the standard.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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