Currently, transurethral resection of bladder tumor (TURBT) is the standard treatment for non-muscle invasive bladder cancer. It is the preferred treatment modality for non-muscle invasive bladder cancer because of its characteristics of small trauma, low bleeding and fast postoperative recovery.TURBT has two purposes: one is to resect all the tumors that are visible to the naked eye, and the other is to resect the tissues for pathological grading and staging. The concept of secondary electrodesiccation has been gradually proposed at home and abroad in the past 10 years. I. The main reason for secondary electrocision 1, the residual positive rate of bladder tumor after the first electrocision is very high, even in the United States, Europe and other large cancer centers this data is as high as 30-52%, so it is necessary to carry out the second TUR to remove the residual tumor tissue. 2. Comparative analysis of pathological specimens after secondary TUR and those after the first surgery revealed that the pathological staging after secondary TUR was higher than that of the initial surgery in 10%-20% of patients, especially those patients whose initial TUR did not cut into the muscle layer or whose muscle layer could not be seen in the specimen. Inaccurate staging also affects the choice of subsequent treatment options and prognosis assessment. Indications for secondary electrocautery 1.Inadequate first TURBt; 2.No muscle layer tissue in the first electrocautery specimen, except TaGl (low grade) tumor and simple carcinoma in situ; 3.T1 stage tumor; 4.G3 (high grade) tumor, except simple carcinoma in situ. In recent years, some scholars have further explored the indications for secondary electrocautery. Suer et al. carried out the comprehensive treatment of secondary electrocautery and postoperative adjuvant radiotherapy and chemotherapy for patients with muscle invasive bladder cancer with bladder retention indication, and found that the tumor-specific survival rate of the secondary electrocautery group was significantly better than that of the control group. Meanwhile, secondary electrocision surgery, lymph node invasion, and hydronephrosis were all predictive factors for tumor-specific survival. Therefore, for patients with muscle invasive bladder cancer who have the indication or willingness to preserve the bladder, secondary electrosurgery may obtain a better prognosis. The timing of secondary electrocautery Too long an interval after the first TURBT will affect the later perfusion chemotherapy, while too short an interval will affect the judgment of the surgeon because of the inflammatory edema and other reactions of the intravesical mucosa, which can be easily confused with the tumor lesions. The results of the latest study showed that secondary electrodesiccation within 6 weeks after the initial TURBT can significantly reduce the recurrence and progression rates of patients and improve the 3-year recurrence-free survival rate. Therefore, it is recommended to perform a second electrodesiccation within 2 to 6 weeks after the initial electrodesiccation. Surgical points of secondary electrosurgery The basic operation procedure of secondary electrosurgery is the same as that of the first TURBT. after satisfactory anesthesia, firstly, comprehensive and careful observation of each wall of the bladder should be made, and special attention should be paid to observing the original tumor area during the operation. The basal part of the original tumor (including the area of inflammatory edema of the surrounding mucosa), other tumors/suspected tumors are sequentially resected, and it is recommended to take biopsies with biopsy forceps or electrosurgical ring at the basal part of the tumor, and random biopsies should be done if necessary, and special attention should be paid to resecting to the deep muscular layer of the bladder during the operation. If the pathologic grade of secondary cystectomy is elevated to muscle invasive bladder cancer, radical cystectomy is recommended. Complications of secondary cystectomy The surgical complications of secondary cystectomy are less, mainly prolonged bleeding time, urethra injury, etc., which can be satisfied after conservative treatment. Why is there such a high tumor positivity rate after secondary electrosurgery? 1. Biological characteristics of bladder cancer: latent early tumors are easy to be missed; high-grade tumors have high malignancy, tumors are easy to be planted and metastasized in the vasculature, etc. 2. Of course, the quality of the initial electrodesiccation surgery is also crucial: if the initial electrodesiccation fails to cut to the muscularis propria layer or the muscularis propria layer can not be seen in the specimen, the rate of tumor positivity found by second electrodesiccation will be increased obviously. VII. Post-secondary electrodesiccation Perfusion It is recommended that immediate perfusion therapy be performed within 24 h after secondary electrodesiccation, but it is not recommended when bladder perforation or severe gross hematuria occurs during secondary electrodesiccation. 1.For low-risk non-muscle invasive uroepithelial carcinoma of the bladder, only a single dose of immediate postoperative bladder instillation chemotherapy can be administered. 2.For intermediate and high risk non-muscle layer invasive uroepithelial carcinoma of the bladder, postoperative single dose immediate bladder perfusion chemotherapy should be followed by follow-up chemotherapeutic agents or BCG maintenance perfusion therapy. 3.For high-risk non-muscle invasive bladder uroepithelial cancer, BCG bladder perfusion therapy is preferred (at least 1 year maintenance).