Impact of Maximal Transurethral Resection on Pathological Outcomes at Cystectomy in a Large, Multi-institutional Cohort

Peter S. Kirk, Yair Lotan, Homayoun Zargar, Kamran Zargar, Adrian S Fairey, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobson, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Wassim Kassouf, Marc A Dall'Era, Srikala S. Sridhar, Jonathan S McGrath, Jonathan Aning, Shahrokh F ShariatAndrew C. Thorpe, Todd M Morgan, Jeff M Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Petros Grivas, Jorge A Garcia, Andrew J Stephenson, Jay B Shah, Siamek Daneshmand, Philippe E Spiess, Bas WG van Rhijn, Peter C. Black, Jonathan L. Wright

Research output: Contribution to journalArticlepeer-review


Purpose: While the presence of residual disease at the time of radical cystectomy for bladder cancer is an established prognostic indicator, controversy remains regarding the importance of maximal transurethral resection prior to neoadjuvant chemotherapy. We characterized the influence of maximal transurethral resection on pathological and survival outcomes using a large, multi-institutional cohort.
Materials and Methods: We identified 785 patients from a multi-institutional cohort undergoing radical cystectomy for muscle-invasive bladder cancer after neoadjuvant chemotherapy. We employed bivariate comparisons and stratified multivariable models to quantify the effect of maximal transurethral resection on pathological findings at cystectomy and survival.
Results: Of 785 patients, 579 (74%) underwent maximal transurethral resection. Incomplete transurethral resection was more frequent in patients with more advanced clinical tumor (cT) and nodal (cN) stage (P Conclusions: In patients undergoing transurethral resection for muscle-invasive bladder cancer prior to neoadjuvant chemotherapy, maximal resection may improve pathological response at cystectomy. However, the ultimate effects on long-term survival and oncologic outcomes warrant further investigation.
Original languageEnglish
Pages (from-to)882-889
Number of pages8
JournalAUA Journal of Urology
Issue number5
Early online date16 Feb 2023
Publication statusPublished - 1 May 2023


  • cystectomy
  • margins of excision
  • neoplasm staging
  • urinary bladder neoplasms


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