Comparison of Perioperative Outcomes including Severe Bladder Injury between Monopolar and Bipolar Transurethral Resection of Bladder Tumors: A Population Based Comparison

Abstract

In this study we used nationwide population based data to compare perioperative outcomes, including severe bladder injury, between monopolar andbipolar transurethral resection of bladder tumors. Data of patients with clinical T2 or less bladder cancer who underwent monopolar or bipolar transurethral bladder tumor resection were collected from 788 hospitals in the Japanese Diagnosis Procedure Combination database 2007-2012. One-to-one propensity score matching was performed. End points assessed were severe bladder injury requiring placement ofadrainage tube or repair surgery within 3 postoperative days, hemostasis procedures consisting of clot removal or transurethral coagulation within 3postoperative days, transfusion, other complications, anesthesia duration, postoperative length of stay and total costs. Multivariate analyses compared outcomes of bipolar and monopolar transurethral bladder tumor resection with gender, age, Charlson comorbidity index, clinical stage, hospital volume and hospital academic status as covariates. A total of 8,188 pairs were generated. Compared with monopolar transurethral bladder tumor resection, bipolar resection was associated with a significantly lower incidence of severe bladder injury (0.3% vs 0.6%, OR 0.57), other complications (4.6% vs 5.8%, OR 0.78), slightly shorter postoperative stay (mean 6.4 vs 6.7 days, difference -3.3%) and slightly lower total costs (mean $4,628 vs $4,727; difference -1.1%, all p <0.05). There were no differences in postoperative hemostasis procedures, transfusion and anesthesia duration. Bipolar transurethral bladder tumor resection was associated with a substantially lower incidence of several perioperative complications including severe bladder injury. The findings support the benefit of bipolar transurethral bladder tumor resection over monopolar resection in real-world clinical practice.