Outcomes and Complications of Bipolar vs. Monopolar Energy for Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Xin Mao,Yong Zhang,Mingshan Yang,Zhongbao Zhou,Yuanshan Cui

doi:10.3389/fsurg.2021.583806

Abstract

Background: Bipolar and monopolar transurethral resections have a stable status for non-muscle invasive bladder cancer (NMIBC). We conducted a meta-analysis to analyze the outcomes and complications of bipolar vs. monopolar energy for transurethral resection of bladder tumors (TURB).Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses was followed. Based on the Population, Intervention, Comparator, Outcomes, and Study Designs (PICOS) strategy, randomized controlled trials were searched in MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the associated articles were also retrieved. The data were calculated by Rev Man v5.3.0.Results: Eleven publications containing an amount of 2, 099 patients were involved in the study. Two groups did not show a significant difference in the mean age and the number of bladder tumors. The results showed that m-TURB had a greater decrease in postoperative hemoglobin level [mean difference (MD) −0.26, 95% confidence interval (CI) −0.48 to −0.04, P = 0.02] and sodium level (MD −0.36, 95% CI −0.62 to −0.10, P = 0.007) compared with b-TURB. B-TURB spent relatively little in hospitalization time (MD −0.52, 95% CI −0.88 to −0.15, P = 0.005) than m-TURB with the exception of operation time (P = 0.47) and catheterization time (P = 0.19). B-TURB did not show a significant difference in the incidence rate of obturator reflex (P = 0.10), bladder perforation (P = 0.32), postoperative blood transfusion (P = 0.28), and clot retention (P = 0.21) compared with the b-TURB group. Besides, there were no significant difference in terms of muscle tissue sampling (P = 0.43), recurrence-free survival at 6 months (P = 0.68) and 12 months (P = 0.78).Conclusions: B-TURB was more effective than m-TURB in minimizing intraoperative or postoperative bleeding with the smaller loss of hemoglobin and the shorter hospitalization time for patients with NMIBC.

Highlights

Bladder cancer is one of the most common malignancies in the United States, and its incidence rate is about 80,470 new cases and 17,670 deaths in 2019 [1, 2]
The forest plot demonstrated that m-TURB had a greater decrease in postoperative hemoglobin level (MD −0.26, 95% confidence interval (CI) −0.48 to −0.04, P = 0.02; Figure 5A) compared with b-TURB
The forest plots showed that mTURB had a significant decrease in postoperative sodium level compared with b-TURB (MD −0.36, 95% CI −0.62 to −0.10, P = 0.007; Figure 5C)

Summary

Introduction

Bladder cancer is one of the most common malignancies in the United States, and its incidence rate is about 80,470 new cases and 17,670 deaths in 2019 [1, 2]. Non-muscle invasive bladder cancer (NMIBC) accounts for ∼80%, and urothelial carcinoma is the main type of histologic classification [3, 4]. Transurethral resection (TUR) is the basis of staging and treatment of bladder tumors [5]. Transurethral resection of bladder tumors (TURB) aims to achieve a definitive diagnosis and remove visible pathological tissue including muscle tissue [6]. Bipolar and monopolar transurethral resections have a stable status for non-muscle invasive bladder cancer (NMIBC). We conducted a meta-analysis to analyze the outcomes and complications of bipolar vs monopolar energy for transurethral resection of bladder tumors (TURB)

Methods

Results

Conclusion