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.