Background The efficacy of Vesical Imaging–Reporting and Data System (VI‐RADS) for the second transurethral resection (TUR) has not been adequately validated. This study aimed to evaluate the utility of the VI‐RADS for high‐risk patients with non‐muscle‐invasive bladder cancer (NMIBC) who are candidates for a second TUR. Methods We retrospectively analyzed 116 patients who received magnetic resonance imaging (MRI) prior to an initial TUR and underwent a second TUR for a diagnosis of high‐risk NMIBC at the initial TUR. MRI images were retrospectively classified according to VI‐RADS. Second TUR outcomes and recurrence‐free and progression‐free survival rates were compared with VI‐RADS scores. Results Ninety‐nine (91%) patients were diagnosed with T1 bladder cancer at the initial TUR. At the second TUR, residual cancer was found in 53 (49%) cases, including five (4.6%) cases of muscle invasion. With a median follow‐up of 41 months, the 2‐year bladder recurrence‐free survival rate was 71% and the 2‐year progression‐free rate was 85%. By two radiologists' consensus, 30 (28%)/49 (45%)/16 (15%)/10 (9.2%)/4 (3.7%) cases were classified as VI‐RADS 1/2/3/4/5, respectively. Of five pT2 upstage cases, three were VI‐RADS 1, one was VI‐RADS 2, and one was VI‐RADS 3. There was no significant association between VI‐RADS and cancer residual rate and pT2 upstage rate in second TUR outcomes, and recurrence‐free and progression‐free survival rates. Conclusion In high‐risk NMIBCs, a certain number of residual cancers and pT2 upstage cases exist after the initial TUR, and a second TUR should be performed regardless of VI‐RADS scores.

The need for a second transurethral resection in high‐risk non‐muscle‐invasive bladder cancer based on the Vesicle Imaging–Reporting and Data System