A 60-year-old man presents with gross hematuria. Cystoscopy shows a papillary bladder tumor. TURBT reveals high-grade T1 transitional cell carcinoma with lamina propria invasion, no muscularis propria in specimen. What is the most appropriate next management step?
- A Intravesical BCG immunotherapy starting 2 weeks post-TURBT
- B Radical cystectomy
- C Re-TURBT within 2–6 weeks ✓
- D Intravesical mitomycin C single instillation only
Correct answer: C. Re-TURBT within 2–6 weeks
Explanation
EAU guidelines mandate re-TURBT within 2–6 weeks when muscularis propria (detrusor muscle) is absent from the initial TURBT specimen of a T1 high-grade tumor, because understaging is common and T2 disease may be present. Re-TURBT detects residual tumor or upstages approximately 20–40% of T1HG cases to T2, altering management to radical cystectomy. BCG therapy is appropriate after adequate staging with muscle in specimen. A single mitomycin C instillation is used in low-risk disease immediately post-TURBT.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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