Efficacy and Safety of Transurethral Laser Surgery Versus Transurethral Resection for Non-Muscle-Invasive Bladder Cancer: A Meta-Analysis and Systematic Review

Abstract

Objective: To compare the efficacy and safety of transurethral laser surgery and transurethral resection of a bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC). Material and Methods: A research was carried out in Medline via PubMed, EMBASE, the Cochrane Library, and Web of Science up to October 20, 2019, to identify articles related to transurethral laser surgery and TURBT for NMIBC. All analyses were done using RevMan5.3 and Stata14. Results: A total of 17 studies involving 2,439 participants were included. The analysis showed no significant difference in operation times (mean difference = –0.2; 95% CI –2.29 to 1.89; p = 0.85) or occurrences of urethral stricture (OR = 0.7; 95% CI 0.24–2.06; p = 0.52). Transurethral laser surgery was associated with a lower incidence of obturator nerve reflex (OR = 0.04; 95% CI 0.02–0.09; p < 0.00001) and bladder perforation (OR = 0.09; 95% CI 0.04–0.23; p < 0.00001), a higher rate of detrusor muscle acquisition (OR = 5.28; 95% CI 2.42–11.49; p < 0.0001), shorter catheterization (mean difference = –1.05; 95% CI –1.41 to –0.68; p < 0.00001) and hospitalization times (mean difference = –0.96; 95% CI –1.59 to –0.33; p = 0.003), and lower rates of bladder irrigation (OR = 0.21; 95% CI 0.13–0.35; p < 0.00001) and recurrence both at 12 months (OR = 0.66; 95% CI 0.48–0.9, p = 0.008) and at 24 months (OR = 0.6; 95% CI 0.41–0.86; p = 0.005). Conclusions: Transurethral laser surgery for NMIBC, as compared to TURBT, is associated with a lower incidence of complications, a lower recurrence rate, and faster postoperative recovery.