Transurethral resection specimens of the bladder: outcome of invasive urothelial cancer involving muscle bundles indeterminate between muscularis mucosae and muscularis propria.

OBJECTIVES Thin muscle fibers on transurethral resection of the bladder (TURB) can represent either muscularis propria destroyed or splayed by urothelial carcinoma or muscularis mucosae, which can be hyperplastic. METHODS The data from 94 patients with invasive bladder cancer seen at our institution (1986-2008) with a mean of 25.4 months of follow-up, who had had an uncertain pathologic diagnosis, were analyzed (72 men and 22 women, mean age 69.4 years). RESULTS Subsequent restaging TURB or a definitive therapeutic procedure performed ≤3 months after the original TURB in 57 patients revealed that 22 patients (38.6%) had nonmuscle-invasive disease and 32 (56.1%) had Stage pT2 or greater disease. The staging for 3 patients remained ambiguous. Of the 94 patients, 37 did not undergo a restaging/therapeutic procedure within 3 months of their original TURB. CONCLUSIONS Restaging TURB is critical when the initial TURB findings are equivocal for muscularis propria invasion. Although this might seem intuitive, 37 of 94 patients did not undergo repeat staging/therapeutic procedures within 3 months of their initial TURB.