Abstract
ABSTRACTObjectives: To assess the safety and the effectiveness of bipolar energy in the transurethral resection of primary large bladder tumours (TURBT) and compare it to conventional monopolar energy.Patients and methods: From November 2015 to June 2017, 80 patients underwent endoscopic resection primarily for large bladder cancer tumours of >3 cm. They were randomly assigned into two groups: 40 patients underwent a TURBT with conventional monopolar current (M-TURBT) and 40 were treated with bipolar current (B-TURBT).Results: There were no statistically significant differences between the two groups for the patients’ demographic and tumour characteristics. There was a significant difference between M-TURBT and B-TURBT for resection time, obturator reflex, hospital stay, and catheterisation time, which were all higher in the M-TURBT group; the mean (SD) resection time was 26.45 (5.73) vs 22.85 (7.52) min (P = 0.048), the obturator reflex was 25% vs 5% (P = 0.025), the median hospital stay and catheterisation times were 2 vs 1 day (P = 0.012 and P = 0.023, respectively). No statistically significant difference was found between the groups for bladder perforation, TUR syndrome, drop in haemoglobin level, and blood transfusion rate. However, there was statically significant difference in the postoperative haematuria rate, which was higher in the M-TURBT group, at 24 patients vs eight in the B-TURBT group (60% vs 20%; P = 0.01). After 1-year follow-up, there was no significant difference in the recurrence rate between the groups.Conclusion: B-TURBT is a safe and effective alternative procedure to M-TURBT for the management of primary large bladder tumours of >3 cm.Abbreviations: CONSORT: consolidated standards of reporting Trials; Hb: haemoglobin; NMIBC: non-muscle-invasive bladder cancer; TUR: transurethral resection; (B-)(M-)TURBT: (bipolar) (monopolar) transurethral resection of bladder tumour
Highlights
Bladder cancer is the fourth most common cancer in men and the eighth most common in women worldwide
One of the risks of using hypotonic fluid during M-TUR of bladder tumour (TURBT) is Transurethral resection (TUR) syndrome, this is more relevant during TUR of the prostate [5]
There was a significant difference between M-TURBT and B-TURBT in the mean (SD) resection time, which was higher in the M-TURBT group, at 26.45 (5.73) vs 22.85 (7.52) min (P = 0.048)
Summary
Bladder cancer is the fourth most common cancer in men and the eighth most common in women worldwide. It is the second most common malignancy affecting the urinary system after prostate cancer [1]. Transurethral resection (TUR) is considered the ‘gold standard’ surgical technique for management of bladder tumours [3]. TUR of bladder tumour (TURBT) using monopolar current (M-TURBT) as the source of energy, is the standard of care [4]. Electric current can stimulate the obturator nerve and cause adductor reflex during resection of laterally situated bladder tumours. The obturator nerve reflex may cause intraoperative complications in terms of bladder wall perforation, excessive bleeding, and cause incomplete resection and a longer hospital stay [6]
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