Monopolar Resection Research Articles

Ex vivo Study of Partial Bladder Resection in a Porcine Model.

Partial cystectomy aims to preserve bladder function, yet its urodynamic impacts remain unclear. We investigate these effects using an ex vivo porcine model, evaluating bladder volume, compliance, and wall thickness, alongside with thermal damage after bi- and monopolar resection. Within an artificial human pelvis, we conducted partial bladder wall resections (5 cm2, 10 cm2). Urodynamic tests and sonography assessed volume, compliance, and thickness changes. Traction force for catheter retrieval and thermal collagen destruction were measured. Bladder compliance decreased by 1.12 and 1.5 after 5 cm2 and 10 cm2 resections, respectively, with volume reductions of 3-6% and 10-18%. Wall thickness decreased by 20% and 30% post-resection. Comparable thermal damage was observed with mono- and bipolar resection methods. Our study outlines urodynamic impacts and technical considerations of partial cystectomy, affirming its endoscopic feasibility while highlighting potential bladder dysfunction risks.

Transurethral Monopolar Resection of the Prostate: Experience of Amirou Boubacar Hospital in Niamey, Niger

Introduction: Benign prostatic hypertrophy (BPH) is a very common urological pathology and occurs in men in their fifties. The clinical manifestation is manifested by symptoms of the lower urinary tract such as dysuria and pollakiuria. Surgical management has been revolutionized by the advent of trans-urethral resection of the prostate (TURP), which is a reference treatment.
 Objective: The objective of this work was to evaluate the results of the first cases of transurethral resection of the prostate at Amirou Boubacar hospital in Niamey.
 Patients and Methods: This was a descriptive study conducted at Amirou Boubacar Hospital in Niamey over the period from December 5, 2021 to June 5, 2022 and involved patients admitted to the urology department of Amirou Boubacar Hospital in Niamey. The variables studied were: age, profession, level of education, marital status, clinical and therapeutic aspect. The data was collected on an individual collection form from hospital records. To analyze the data, spss version 20 software was useful and allowed us to obtain our results.
 Results: During our study period we had 28 cases of TURP out of a prevalence of 9.20% of all emergencies. The most represented age group is that of 60 – 69 years with 60.72%. Farmers represented (71.43%), civil servants (21.43%). Shopkeepers (7.14%). From a clinical point of view, all our patients consulted for dysuria and pollakiuria, an average IPSS score (International Prostate Symptom Score) of 22.33. The average total PSA (Prostate Specific Antigen) was 3 ng / ml, an average prostate volume of 45.20 g. The average duration of intervention was 41 min. a catheterization of 48 hours, as a complication we note 3.57% a type of severe hyponatremia
 Conclusion: Benign prostatic hypertrophy is a frequent pathology in urology whose surgical management has been revolutionized by TURP (Transurethral Resection of the Prostate) being the gold standard. This shortens the hospitalization period with a good improvement in the patient's quality of life and micturition.

Comparison of Bipolar and Monopolar Transurethral Resection of Bladder Tumours: A Randomised Clinical Study

Introduction: The standard treatment of Urinary Bladder Cancer (UBC) is Transurethral Resection of Bladder Tumours (TURBT) commonly using a monopolar resection system. Bipolar-TURBT (B-TURBT) is associated with better haemostasis than MonopolarTURBT (M-TURBT). Despite this, there exists controversy whether B-TURBT can completely replace M-TURBT. Aim: To assess the perioperative outcomes of B-TURBT and compare it with the conventional monopolar system (M-TURBT). Materials and Methods: The present randomised clinical study was conducted at the Department of Urology of SCB Medical College, Cuttack between January 2018 and January 2020. Fifty patients of either sex, aged >18 years with urinary bladder tumour size of ≤4 cm were included in the study. Patients were randomly assigned into B-TURBT and M-TURBT treatment groups. Demographic data (age and sex), morphology, location, shape, grade, stages of transitional cell carcinoma, degree of artifact were analysed and compared. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. The qualitative and quantitative variables between the groups were compared using independent sample t-test and chi-square test, respectively. A p-value<0.05 was considered statistically significant. Results: A total of 50 patients with UBC were evaluated in this study where the majority of patients were male 45 (90.0%) with mean age 60.9 years. The most common morphologies were papillary tumour (28.0%), broad solid mass (22.0%), and papillary solitary (22.0%). Total 25 patients underwent M-TURBT and 25 patients underwent B-TURBT. Older patients (>55 years) had a higher rate of severe artifact compared to younger patients (<55 years). The B-TURBT had a significantly lower rate of artifact compared to M-TURBT (p-value <0.001). The need for secondary procedure was comparatively higher in M-TURBT than in bipolar resection (p-value=0.253). The obturator jerk and bladder perforation were not observed in this study. Conclusion: The B-TURBT had a lower incidence of severe artifact and restaged TURBT as compared to M-TURBT. Thus, B-TURBT is a safer and more effective treatment for patients with UBC.

318 Monopolar Versus Bipolar TURBT: Bradford Experience

Abstract Aim To compare the safety and efficacy of monopolar vs bipolar TURBT. Method This was a randomized control trial done over 18 months with patients being allotted randomly into the bipolar and monopolar arms. The study was carried out in the department of urology at BRI and YC. All consecutive patients undergoing TURBT for suspected bladder tumors were eligible for the study. The diagnosis was based on imaging and/or cystoscopy. Exclusion criteria included refusal to participate, unfitness for spinal anesthesia, and lack of tumor in the lateral wall. The primary objective was to compare the incidence of obturator jerk in monopolar and bipolar TURBT. The secondary objective was to study and compare the quality of histopathology specimen, detrusor muscle identification, and bladder perforation. Results A total of 95 transurethral resections were done over the study period. All these patients were eligible for inclusion in the study, 50 in monopolar and 45 in the bipolar arms, were analyzed. Both the study groups were comparable for age, sex, and tumor size. The incidence of obturator jerk was greater in the bipolar arm (8.8 %% vs 2%, P- value=2.25). The difference in the incidence of obturator jerk in the two arms was not statistically significant (Chi-Square test). There was no significant difference in either of the secondary outcomes. Conclusions The bipolar transurethral resection of the bladder tumor was not superior to monopolar resection concerning the obturator jerk, bladder perforation, and histopathological quality of the resected specimen.

Endourological treatment of non-muscular-invasive bladder tumors

Background: Transurethral resection of the bladder is one of the essential methods in the diagnosis, treatment and management of non-muscularinvasive bladder cancer. The purpose of the procedure is to remove completely all visually detected tumors with a following establishment of a very precise histological diagnosis. The aim of the study is to compare the results of conventional transurethral endoscopic treatment and the En-bloc resection method using different types of energy sources in the treatment of bladder tumors. Material and methods: A total number of 88 patients underwent endourological interventions. Regarding the distribution, 23 patients had conventional transurethral resection, 22 – En-bloc monopolar resection, 21 – En-bloc bipolar resection and 22 – En-bloc with Thu:YAG laser. Clinical data, intraoperative and postoperative data and also the histopathological examination results were compared. Results: The compared groups were heterogeneous by age, sex, tumor characteristic (size, number, location). No significant differences were observed during the operations, comparing the intraoperative and postoperative complications of the studied groups. The detrusor musculature was detected in 74% of cases after conventional transurethral resection, in 91% of cases of En-bloc monopolar resection, in 95% of cases of En-bloc bipolar resection and in 96% of cases of En-bloc Thu:YAG laser. Conclusions: The En-bloc resection technique of non-muscular-invasive bladder tumors is a safe and effective method comparing with the conventional transurethral resection; it allows more favorable postoperative results and obtaining better quality tumor samples which allow establishing correct diagnosis of the disease.

English

BACKGROUND In this study we wanted to compare the clinical outcomes in terms of symptom improvement and perioperative results of monopolar and bipolar trans urethral resection of prostrate (TURP) for benign prostatic hyperplasia (BPH) and evaluate the advantages of bipolar transurethral resection over the monopolar resection. METHODS A total of 150 patients who underwent trans urethral resection of prostate (TURP) surgical procedure, (n = 75 for monopolar TURP) and (n = 75 for bipolar TURP) for BPH enrolled between December 2018 to November 2020 at the Department of Urology in VSSIMSAR, Burla, Odisha. RESULTS Significant differences were found in operating time in minutes (45.11 ± 4.029 vs 41.99 ± 5.020, P < 0.025) between monopolar and bipolar TURP. The mean sodium falls in post-operative period in bipolar and monopolar TURP was 7 Meq and 3 Meq respectively which was statistically significant (P - value less than 0.05). Bipolar TURP is equally effective as monopolar in reducing the international prostate symptom score (IPSS), improvement in quality of life, maximum urinary flow rate. Trans urethral resection (TUR) syndrome was reported in two patients who had undergone monopolar resection without any incidence in bipolar group. 3 patients in monopolar group developed clot retention compared to 1 in bipolar group in post-operative period. Fall in haemoglobin (Hb) and packed cell volume (PCV) was more with monopolar group but insignificant. CONCLUSIONS Bipolar TURP is safe and equally effective as monopolar TURP with advantage of shorter operative time and absence of dilutional hyponatremia and TUR syndrome, but needs large randomized trials with long follow up to confirm its efficacy and safety. KEYWORDS Monopolar TURP; Bipolar TURP; Benign Prostate Hyperplasia

Two-Stage TURP as an Option for Treatment of Large Prostates in Resource Poor Environments

Transurethral resection of the prostate (TURP) is the gold standard of surgical therapy of benign prostatic hyperplasia (BPH) for prostates <100 ml. This study was carried out to describe our experience with and outcome of staged TURP for large prostates (>100 ml). A review of the records of all the patients who underwent staged TURP for large BPH at a specialist urology center. They had two-stage monopolar resection using a size 26F continuous flow resectoscope and 5% Dextrose water irrigation. Staged-TURP were performed by a single Consultant Urologist under spinal anesthesia. Patients’ age, Co-morbidities, Prostate-specific Antigen (PSA), Abdominal Ultrasound scan (USS) estimated prostate volume, Pre-operative Packed Cell Volume (Pre-op PCV), Post-operative Packed Cell Volume (Post-op PCV), Resection Weight for 1st stage (RW I), Resection Weight for 2nd stage (RW II), Resection Time for 1st stage (RT I), Resection Time for 2nd stage (RT II), blood transfusion were obtained and analyzed. Follow up was for a minimum of 9 months and the outcome and development of complications noted. Statistical analysis was done using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM, Chicago, USA). Means and percentages were calculated, and paired sample T test was used to compare variables between 1st stage and 2nd stage. P value < 0.05 was considered significant. Twenty-five patients with a mean age of 72.32±7.98 years were analyzed. Most (88%) were on indwelling Foley’s urethral catheter before surgery. The mean PSA and prostate volume were 25.61±22.08 ng/ml and 221.56±62.78 cm3. There were significant differences between Pre-op PCV and Post-op PCV (p<0.001); RWI and RWII (p<0.001); and RTI and RTII (p<0.001). Nineteen patients (76%) received perioperative transfusion. Most patients voided satisfactorily following catheter removal except one who developed acute urinary retention (AUR). No cases of TUR syndrome, post-operative sepsis, DVT or PE and urethral stricture were recorded. Staged TURP is safe and effective treatment modality for patients with large prostates in the absence of more recent endoscopic options.

Irrigation fluid absorption during transurethral bipolar and laser prostate surgery: a systematic review.

Transurethral endoscopic procedures using bipolar current, or laser energy are nowadays widely accepted and have replaced the traditional monopolar resection. A major advantage of these techniques is the utilization of isotonic saline as irrigation solution, which minimizes side effects such as symptoms associated to classical transurethral resection syndrome (TUR-syndrome). Nonetheless, clinically significant IFA also occurs with saline and is determined by pressure gradients, systemic resistance and by the amount of irrigation fluid. We aimed to investigate the extend of IFA and symptoms due to volume overload during bipolar transurethral resection (bTUR) and laser procedures of the prostate. We performed a systematic literature search using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Search terms were TUR, transurethral, laser, HoLEP, ThuLEP, greenlight, enucleation, fluid absorption, fluid uptake, and TUR-syndrome. Mean and maximum IFA during bTURP ranges between 133 and 915ml and 1019ml and 2166ml, respectively. Absorption during laser procedures can be significant with maximum values up to 4579ml and mainly occurs during prostate vaporization techniques. Incidence of moderate to severe symptoms from iso-osmolar volume overload reaches 9%. Irrigation fluid absorption during bTUR and laser surgery of the prostate is not negligible. Iso-osmolar overhydration with development of non-classical TUR-syndrome should be identified peri- and postoperatively and surgical teams should be aware of complications. Breath ethanol, venous pH, serum chloride, and bicarbonate could be markers for detecting dangerous events of IFA with saline.

P0760 - Higher detection of bladder tumor urothelial variants by using plasma kinetic bipolar resection than monopolar resection

P0760 - Higher detection of bladder tumor urothelial variants by using plasma kinetic bipolar resection than monopolar resection

Bipolar versus monopolar resection of the prostate for lower urinary tract symptoms caused by benign prostatic obstruction

Bipolar versus monopolar resection of the prostate for lower urinary tract symptoms caused by benign prostatic obstruction

Transurethral Resection of the Prostate (TURP): About 146 Cases at Sheikh Zayed Hospital in Nouakchott Mauritania

Introduction: Transurethral resection of the prostate (TURP), entered our service in October 2015, since then it became a part of the service daily activity. The aim of our study is to assess the acceptance of the technic by our patients and by the nursing staff and to analyze the results of our initial experience. Materials and Methods: Retrospective study over 14-month (October 2015 to December 2016); bringing together all the patients who received TURP. The inclusion criteria are to have benefited from a TURP in our service. The exclusion criteria all patients operated by other techniques. It was a monopolar resection of the prostate using a glycocolle loop, the size limit of the prostate was 65 cc or less. A questionnaire on the knowledge of the technique and its acceptance is made. The parameters studied the age of the patient; surgical indications; the course of the operation, the complications and the course. The frequency of TURP compared to other techniques and the demand for this technique by patients. The urinary catheter was left in place for 4 days, the patients were seen again on day 7 after the catheter was removed to assess the urine flow, a question regarding the opinion of the nursing staff was included and analyzed separately. Results: The total number of patients was 146; the mean age was 68.2 years. The main cause of consultation was urine retention 65%. The average duration of the intervention was 56 minutes. The average length of hospital stay was 28 hours. The urinary catheter was removed on day 4. Complications were bleeding in 7% of cases requiring blood transfusions. Failure to remove the indwelling catheter leads to revision via the transurethral route. The TURP syndrome was observed in 2 patients in our early patients but quickly resolved. The outcome was favorable in 75% of cases. Post operating management give satisfaction for nurse and acceptance was a success. Conclusion: TURP is now a routine surgical activity; it seems to have an upright place for BPH in our department; its impact on morbidity was remarkable.

En-bloc resection of urinary bladder tumour - a prospective controlled multicentre observational study.

IntroductionTransurethral resection of bladder tumour (TURBT) is one of the most commonly performed urologic procedures. Because of the shortcomings of conventional TURBT, the en-bloc resection concept was created.AimTo analyse the influence of en-bloc technique on surgical and oncological outcomes of TURBT performed with electric current.Material and methodsThis non-randomized, prospective controlled multicentre study enrolled 427 consecutive patients undergoing TURBT performed by five experienced endourologists in five academic institutions. Choice of procedure was at the discretion of the surgeon. The vast majority of patients underwent monopolar resection. The en-bloc procedure was performed with Collin’s knife or the classic resection loop. Study end-points were surgery, catheterization and hospitalization time, presence of muscularis propria (MP) in the specimen and 3-month recurrence-free survival (RFS).ResultsThe study included 427 (274 conventional TURBT vs. 153 en-bloc) patients with mean age of 69 years (range: 18–99). There were more cases with MP present in the specimen in the en-bloc group (91.3% vs. 75.5%; p < 0.001). Surgery and hospitalization times were statistically shorter in the en-bloc group (both p < 0.05). A borderline significant difference was noted when the number of residual tumours in reTURBTs was analysed, with fewer cases of residual tumour in the en-bloc group (p = 0.051). RFS at 3 months was higher in the en-bloc group (88.4% vs. 80.1%; p = 0.027). After propensity score matching, differences in MP presence, hospitalization time and 3-month RFS status remained statistically significant.ConclusionsWhen compared to conventional TURBT, en-bloc resection of bladder tumour is associated with higher percentage of MP presence in histopathological specimen, higher 3-month RFS and shorter hospitalization time.

MP49-13 SAFETY AND EFFICACY OF MONOPOLAR VS BIPOLAR TRANSURETHRAL RESECTION OF BLADDER TUMOR

You have accessJournal of UrologyBladder Cancer: Invasive I (MP49)1 Apr 2020MP49-13 SAFETY AND EFFICACY OF MONOPOLAR VS BIPOLAR TRANSURETHRAL RESECTION OF BLADDER TUMOR Manish Pradhan* and Diwas Gnyawali Manish Pradhan*Manish Pradhan* More articles by this author and Diwas GnyawaliDiwas Gnyawali More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000911.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since its inception, TURBT has been performed with monopolar cautery. Bipolar resection has now been proved to be a safe, effective alternative for prostate TUR. Initial studies of bipolar TURBT were promising with fewer fluid and electrolyte abnormalities, and a decreased incidence of obturator jerk. However, no high level evidence exists and the exact role of bipolar TURBT remains undefined. Hence this study was intended to compare the safety and efficacy of bipolar and monopolar resection of bladder tumor. METHODS: This was a randomized control trial done for one year with patients being allotted randomly into bipolar and monopolar arm. The study was carried out in the department of urology and transplant surgery TUTH. All consecutive patients undergoing TURBT for suspected bladder tumors were eligible for the study. Diagnosis was based on imaging and/or cystoscopy. Exclusion criteria included refusal to participate, unfitness for spinal anesthesia and lack of tumor in lateral wall. Primary objective was to compare the incidence of obturator jerk in monopolar and bipolar TURBT. The secondary objective was to study and compare the decrease in hemoglobin, recoagulation and transfusion requirements, bladder perforation, decrease in sodium, resection syndrome and resection time, hospital stay in two groups, detrussor muscle identification and pathological quality of resected specimen. RESULTS: A total of 82 transurethral resections were done over the study period. After exclusion of 12 patients, 70 patients, 36 in monopolar and 34 in bipolar arms, were analyzed. Both the study groups were comparable for age, sex and tumor size. The incidence of obturator jerk was greater in monoplar arm (47.2% vs 26.4%, p=0.073). There was no significance difference in most of the secondary outcomes. The only differences was in lesser hemoglobin drop in bipolar arm (0.49gm/dl vs 0.98gm/dl, p=0.016) and lesser resection time seen in bipolar arm (33.0 mins vs 46.8mins, p=0.008). CONCLUSIONS: The bipolar transurethral resection of bladder tumor was not superior to monopolar resection with respect to the obturator jerk, recoagulation and transfusion requirements, bladder perforation, decrease in sodium, resection syndrome, hospital stay and pathological quality of resected specimen. However, there was significantly lower hemoglobin drop and resection time was significantly less when bipolar resection was used. Source of Funding: Urological department © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e746-e746 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manish Pradhan* More articles by this author Diwas Gnyawali More articles by this author Expand All Advertisement PDF downloadLoading ...

Hysteroscopic Endometrial Polypectomy: Comparative Retrospective Study of the Morcellator System versus Electrosurgical Resection

A single-center observational retrospective comparative study was performed, including 190 patients who underwent hysteroscopic resection of endometrial polyps from January 2017 to December 2017. The hysteroscopic techniques were TRUCLEAR 5.5® to morcellation and Karl Storz® monopolar resection.

Bipolar Transurethral Resection of Bladder Tumor Provides Better Tissue for Histopathology But Has No Superior Efficacy and Safety: A Randomized Controlled Trial.

Bipolar transurethral resection of bladder tumors (TURBTs) has been claimed to have lesser complications and better specimen quality, but recent studies have contradictory results, and hence, we conducted this study to compare the clinical efficacy and safety of monopolar and bipolar electrosurgical modalities in TURBTs. A total of 287 patients were enrolled in the study and underwent TURBTs between July 2015 and September 2016. Patients undergoing surgery under general anesthesia and restage procedure were excluded from the study. Patient demographic profile, tumor characteristics, and complications of the procedures such as obturator jerk, bladder perforation, blood loss, need for resurgery, and transurethral resection syndrome were recorded. Tumor specimens were analyzed for stage, grade, deep muscle invasion, and quantity and quality of thermal artifacts. A total of 160 patients were block randomized and analyzed with 80 patients in either group. Patient demographics and tumor characteristics were comparable between the groups. Change in hemoglobin levels and incidence of bladder perforation were comparable between the groups. A higher proportion of patients in bipolar group had obturator jerk compared with those in monopolar group, however, it was not statistically significant (24% vs 14%; p = 0.23). A higher proportion of patients in bipolar group did not have thermal artifacts when compared with monopolar group (27.5% vs 5%; p < 0.0001). The operative risks of bipolar TURBT such as obturator jerk, bladder perforation, and blood loss are comparable with monopolar resection. However, less thermal artifacts in tissue samples obtained with bipolar resection may be helpful to the pathologist in interpretation of histopathologic findings.

WITHDRAWN: Transurethral resection of prostate: A comparison of standard monopolar versus bipolar saline resection

WITHDRAWN: Transurethral resection of prostate: A comparison of standard monopolar versus bipolar saline resection

¿Resección transuretral bipolar o monopolar para hiperplasia prostática benigna?

Introduction Transurethral resection is currently considered as standard endoscopic treatment for lower urinary tract obstruction due to benign hyperplasia under 80 cc. Monopolar resection loops has been traditionally used but bipolar energy has recently displaced precedent technology. The purpose of this summary is to evaluate the efficacy and safety of both technologies. Methods To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions We identified 13 systematic reviews including 32 primary studies, among them 31 randomized trials. We concluded although there may be no difference in terms of efficacy among both techniques, the use of bipolar energy reduces the incidence of transurethral resection syndrome and probably reduces the risk of bleeding that requires red blood cell transfusion.

Comparative Effectiveness of Transurethral Resection Techniques in the Inpatient Setting for Benign Prostatic Hyperplasia

IntroductionMonopolar transurethral resection is the conventional surgical standard of care for bladder outlet obstruction due to benign prostatic enlargement. Bipolar resection and GreenLight™ photovaporization have emerged as options with favorable safety profiles. The literature comparing these modalities is limited by sample size and absence of cost data. We compared costs and short-term safety of monopolar, bipolar and laser vaporization techniques in an all-payer inpatient discharge database. MethodsA total of 20,323 men 40 to 80 years old with a diagnosis of benign prostatic hyperplasia who underwent an outlet procedure between 2003 and 2013 were identified in the Premier Research Database. Using propensity weighted logistic regression we assessed treatment trends and perioperative safety outcomes. ResultsMonopolar resection remained the most commonly performed procedure between 2003 and 2013. However, its use decreased by 20% (p <0.001). Whereas there were no differences between bipolar and monopolar resection with regard to operative time (p >0.99), length of stay (p=0.82) and 90-day complication rates (p=0.34), GreenLight photovaporization was associated with prolonged operative time (+12 minutes, 95% CI 10.25 to 13.75, p <0.001) and shorter length of stay (OR 0.51, 95% CI 0.37 to 0.7, p <0.001) compared to monopolar resection. Bipolar resection ($982, 95% CI 509–1,456; p <0.001) and GreenLight photovaporization ($1,536; 95% CI 1,296–1,775; p <0.001) were associated with greater 90-day direct hospital costs than monopolar resection. GreenLight photovaporization was associated with decreased odds of dilutional hyponatremia, stricture formation and prostatitis relative to monopolar resection. ConclusionsWe found a modest perioperative safety benefit with bipolar resection and GreenLight photovaporization relative to monopolar resection. However, both procedures were associated with higher costs.

Frequency of endometrial cancer and atypical hyperplasia in infertile women undergoing hysteroscopic polypectomy.

We aimed to determine the frequency of endometrial cancer in infertile women undergoing hysteroscopic endometrial polypectomy for endometrial polyps. A total of 1035 infertile patients who underwent office-based hysteroscopic polypectomy at Sugiyama Clinic Marunouchi between July 2011 and October 2015 were eligible for this retrospective study. All patients had been diagnosed with endometrial polyps via hysterofiberscopy prior to operation, and they underwent hysteroscopic endometrial polypectomy using a resectoscope with monopolar resection. Surgical specimens were examined histopathologically. Characteristics of patients diagnosed with endometrial cancer on histopathological examination were evaluated retrospectively. The median age of patients was 32years (range, 19-44years). On histopathological examination, endometrial cancer was found in 10 patients (0.97%). Each histological type of endometrial cancer was represented as follows: three cases of endometrioid adenocarcinoma G1; one of endometrioid adenocarcinoma G2; two of endometrioid adenocarcinoma G3; and four of atypical endometrial hyperplasia. The median age of endometrial cancer patients was 34years (range, 28-41years), and the median body mass index was 21.2kg/m2 (range, 16.7-29.9kg/m2 ). Nine endometrial cancer patients were nulliparous, and all had undergone infertility treatment, with only one woman having delivered a healthy baby. An ovulation disorder was noted in four patients, with obesity (body mass index>25kg/m2 ) in just two. Polycystic ovary syndrome was concomitantly observed in one patient. However, abnormal vaginal bleeding was not noted in any of these patients. Hysteroscopic polypectomy should be performed when endometrial polyps are detected on investigational screening, and surgical specimens should be checked for the presence of malignancy.

A novel transurethral resection technique for superficial bladder tumor: retrograde en bloc resection

BackgroundTransurethral resection of bladder tumor (TURBT) is the standard approach to bladder tumors but suffers from several disadvantages. The aim of this study was to evaluate the safety and efficacy of a novel procedure of retrograde en bloc resection of bladder tumor (RERBT) with conventional monopolar resection electrode for the treatment of superficial bladder tumors.MethodsRERBT and conventional TURBT (C-TURBT) were conducted, respectively, in 40 and 50 patients diagnosed with superficial papillary bladder tumors. In the RERBT group, the tumors were en bloc removed retrogradely under direct vision using a conventional monopolar electrode. Patients’ clinicopathological, intraoperative, and postoperative data were compared retrospectively between the RERBT and C-TURBT groups.ResultsOf the 90 patients, 40 underwent RERBT and 50 underwent C-TURBT. Both groups were comparable in clinicopathological characteristic. RERBT could be performed as safely and effectively as C-TURBT. There were no significant differences in operative time and surgical complications. The cumulative recurrence rates between groups were similar during up to 18 months follow-up. The detrusor muscle could be identified pathologically in 100% of RERBT tumor specimens and the biopsy of tumor bases, but only in 54 and 70%, respectively, of C-TURBT samples (P < 0.01).ConclusionsThe RERBT technique is feasible and safe for superficial bladder tumors using conventional monopolar resection setting, with the advantages of adequate tumor resection and the ability to collect good quality tumor specimens for pathological diagnosis and staging compared to conventional TURBT.