High-grade, non-muscle-invasive bladder cancer poses many difficult diagnostic and therapeutic challenges. The superficial, yet high-risk, nature of disease progression exemplifies the unique behavior of this form of bladder cancer. An adjunct to managing this difficult problem is a second staging transurethral resection of the bladder tumor (TURBT). This article reviews the pros and cons of a second staging TURBT and how it may impact the management of high-grade, low-stage superficial bladder cancer.