<p><strong> </strong><strong>In patients with non-muscle invasive disease who underwent an incomplete initial resection (not all visible tumor treated), clinicians should perform repeat TUR or endoscopic treatment of all remaining tumors, if technically feasible. (<em>Strong Recommendation; Evidence Level: Grade B</em>) </strong></p>
Discussion
Discussion
<p>Incomplete resection is likely a significant contributing factor to what has been described and diagnosed as early recurrences, as tumors have been noted at the first follow-up cystoscopic evaluation in up to 45% of patients.<sup>62</sup> The Panel recognizes specific, albeit rare, circumstances in which TUR is not likely to impact clinical management and may be omitted for patients with incompletely resected non-muscle invasive disease. Examples of such patients include those with large-volume, high-grade tumors not amenable to complete endoscopic resection for whom immediate radical cystectomy is planned. An additional example includes those with a tumor diagnosed within a bladder diverticulum and for whom subsequent surgical resection (e.g., partial or radical cystectomy) is planned. However, for the majority of patients, complete resection is essential for adequate staging and optimal clinical management.</p>
<p>Although surgeons may utilize BLC for this situation, of note, there is insufficient evidence in this repeat TUR setting to support the routine use of enhanced or BLC versus standard WLC, particularly in light of the noted increase in false positive diagnosis with BLC following recent TURBT.<sup>77, 150, 151</sup></p>