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

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.

Framework for a living systematic review and meta-analysis for the surgical treatment of bladder cancer: introducing EVIglance to urology

“… 35 , Mao et al . 36 , Krajewski et al . 37 ); Photodynamic diagnosis versus white light TURBT (Kausch et al 38 , Maisch et al 39 , Veeratterapillay et al 40 ).…”

Endoscopic laser en bloc removal of bladder tumor. Surgical radicality and improvement of the pathological diagnostic accuracy

“…Monopolar energy in cutting loop is the most used current for the treatment of NMIBC although it is correlated with some adverse events including blood loss or disorder of electrolyte balance for mannitol absorption. Recently, use of bipolar energy has spread due to reduced risk of metabolic alterations and improved precision of resections (6)(7)(8). In 1984, Food and Drug Administration (FDA) approved the use of laser in bladder resection.…”