A 58-year-old male presents with frank haematuria and on cystoscopy a 3 cm papillary tumour is found on the posterior bladder wall. CT urogram shows no upper tract disease. Transurethral resection of the bladder tumour (TURBT) histology reveals T1 high-grade urothelial carcinoma with detrusor muscle in the specimen and no lymphovascular invasion. The appropriate next step is:
- A Radical cystectomy immediately
- B Re-TURBT within 4–6 weeks followed by intravesical BCG induction ✓
- C Intravesical mitomycin C single instillation only
- D Surveillance cystoscopy at 3 months only
Correct answer: B. Re-TURBT within 4–6 weeks followed by intravesical BCG induction
Explanation
For T1 high-grade non-muscle-invasive bladder cancer (NMIBC), EAU/AUA guidelines recommend re-TURBT at 4–6 weeks to confirm staging (detect occult T2 upstaging in ~20–30%) and ensure complete resection, followed by intravesical BCG induction and maintenance immunotherapy. Single-dose post-TURBT chemotherapy is for low-risk disease. Immediate cystectomy is reserved for T1HG with carcinoma-in-situ, multiple recurrences, or BCG-unresponsive disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.