Systematic review and meta-analysis on bipolar versus monopolar transurethral resection of bladder tumors

Wojciech Krajewski; Łukasz Nowak; Marco Moschini; Andrea Mari; Ettore Di Trapani; Evanguelos Xylinas; Andrzej Tukiendorf; Sławomir Poletajew; Romuald Zdrojowy

doi:10.21037/tau-20-749

Systematic review and meta-analysis on bipolar versus monopolar transurethral resection of bladder tumors

Transl Androl Urol. 2021 Jan;10(1):37-48. doi: 10.21037/tau-20-749.

Authors

Wojciech Krajewski¹, Łukasz Nowak¹, Marco Moschini², Andrea Mari³, Ettore Di Trapani⁴, Evanguelos Xylinas⁵, Andrzej Tukiendorf⁶, Sławomir Poletajew⁷, Romuald Zdrojowy¹

Affiliations

¹ Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland.
² Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
³ Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
⁴ Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁵ Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
⁶ Department of Public Health, Wrocław Medical University, Wrocław, Poland.
⁷ Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland.

Abstract

Background: Transurethral resection of bladder tumour (TURB) is the initial and crucial step in the management of non-muscle invasive bladder cancer (NMIBC), having both diagnostic and therapeutic role. For many years, the gold standard for TURB was monopolar TURB (mTURB), however, it is associated with several complications related to its technical details. To overcome limitations of mTURB, TURB using bipolar technology (bTURB) has been developed. So far, making unequivocal statement about definitive advantage of bTURB over mTURB was difficult. The aim of this study was to systematically evaluate and compare the efficacy and safety of bTURB with mTURB.

Methods: A systematic search was conducted independently by two authors on the 4 electronic databases, including PubMed, Scopus, Embase and Cochrane Library, according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Nine comparative prospective studies with randomization (8 RCTs and 1 post-hoc analysis of RCT) were eligible to be included in this meta-analysis.

Results: After extraction, data were pooled to conduct the meta-analysis. The following outcomes were analysed: operation time, catheterization time, length of hospital stay, decrease in postoperative haemoglobin level, obturator nerve reflex rate, bladder perforation rate, transfusion rate, TUR syndrome rate, one year recurrence rate, failures of detrusor muscle detection. bTURB was associated with decreased operation and hospitalization time. There were no statistically significant differences between bTURB and mTURB in terms of catheterization time, decrease in haemoglobin level, postoperative complications rates, recurrence rates and pathologic outcomes.

Conclusions: This meta-analysis corroborates that bTURB shows significant advantage over mTURB in terms of operation and hospitalization time while other outcomes are comparable.

Keywords: Bladder cancer (BC); bipolar; monopolar; transurethral resection of bladder tumour (TURB).