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Abstract
Monopolar Transurethral resection of bladder tumor (TURBT) has been a gold standard for bladder tumor. Initial studies of bipolar TURBT were promising, however, no high level evidence exists and its exact role remains undefined. We compared the safety and efficacy of bipolar and monopolar TURBT. Primary objective was to compare the incidence of obturator jerk. The secondary objectives included the comparison of decrease in hemoglobin, recoagulation and transfusion requirements, bladder perforation, decrease in sodium, resection syndrome and resection time, hospital stay, detrusor muscle identification and severe cautery artifact in resected specimen in two groups. A randomized control trial was conducted for one year. All patients undergoing TURBT for suspected bladder tumors were eligible. Patient’s refusal to participate, unfitness for spinal anesthesia and lack of tumor in lateral wall were excluded. Of the 118 TURBT done during study period, 48 were excluded and 70 patients, 36 in monopolar and 34 in bipolar arms, were analyzed. The incidence of obturator jerk was less in bipolar arm but not significantly different (26.4% vs. 47.2%, p=0.073). There was no significance difference in most of the secondary outcomes except lesser hemoglobin drop (0.49gm/dl vs. 0.98gm/dl, p=0.016) and lesser resection time in bipolar arm (33.0 mins vs. 46.8mins, p=0.008). Bipolar was not different to monopolar TURBT with respect obturator jerk and most of the secondary outcomes. However, with bipolar TURBT, there was significantly less resection time and although hemoglobin drop was less as well, it was not clinically significant.
Highlights
Transurethral resection of bladder tumor (TURBT) is a primary modality of treatment for superficial bladder cancer[1] and helps in tissue diagnosis and further management in muscle invasive bladder cancer.[2]
Eighty-two patients were randomized into two arms after exclusion of 30 patients who had tumor location other than at lateral wall and six patients who were unfit for anesthesia
The bladder perforation occurred in three patients in mTURBT and in 1 patient in bTURBT
Summary
Transurethral resection of bladder tumor (TURBT) is a primary modality of treatment for superficial bladder cancer[1] and helps in tissue diagnosis and further management in muscle invasive bladder cancer.[2] Monopolar system (mTURBT) has been a gold-standard treatment for non-muscle invasive bladder cancer, many complications have been reported, such as electrolyte abnormalities and bladder perforation because of obturator jerk.[3] Tumor in difficult location and large size prompted for the search for improved surgical methods.[4]. Earlier studies on bTURBT have indicated improved hemostasis, decreased obturator nerve stimulation rate, decreased bladder perforation, 4, 6 and good safety in patients with certain specific conditions such as anticoagulant therapy, cardiac pacemaker etc.[7] bTURBT has been reported to result in lesser cautery artifact in resected specimen.[8]
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