<p><strong> </strong><strong>In patients with Ta low- or intermediate-risk disease, clinicians should not perform radical cystectomy until bladder-sparing modalities (staged TURBT, intravesical therapies) have failed. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>Low-grade, non-invasive tumors very rarely metastasize, and even large-volume, multifocal cancers can usually be managed with techniques such as staged resection. Patients with low-grade recurrences can be successfully managed with intravesical chemotherapy<sup>288</sup> or BCG.<sup>234, 289, 290</sup> In addition, small, multifocal recurrences despite intravesical therapy can usually be treated effectively with office fulguration, repeat TURBT, intravesical chemoablation, or even surveillance in select cases.<sup>69-72, 152, 153, 231</sup></p>