En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis

Abstract

IntroductionWe performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer. MethodsA systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models. ResultsEn-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50–0.78; p < 0.001), catheterization-time (MD: –0.66; 95%CI: –1.02–[–0.29]; p < 0.001), length of hospital stay (MD: –0.95; 95%CI: –1.55–[–0.34]; p = 0.002), postoperative bladder irrigation duration (MD: –6.06; 95%CI: –9.45–[–2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02–0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06–0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61–1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: –1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14–1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. ConclusionsEn-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.