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Safety and efficacy of bipolar versus monopolar transurethral resection of bladder tumor: a systematic review and meta-analysis

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A Letter to the Editor to this article was published on 19 May 2020

Abstract

Purpose

Transurethral resection of bladder tumor is the standard of care for the management of patients with bladder mass. Primary objective of this study was to compare safety and efficacy of the two energy modalities used for TURBT (monopolar and bipolar).

Materials and methods

Systematic literature search of various electronic databases was conducted to include all the randomized studies comparing two groups. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019139987).

Results

In the present review, eight RCTs including 1147 patients were included. Resection time, hospital stay and catheter duration were significantly shorter with bipolar group. There was no significant difference in incidence of obturator reflex (OR 0.65, CI [0.35, 1.2], p = 0.17), whereas incidence of bladder perforation was significantly higher in the monopolar group (6.4% versus 3.3%, p = 0.01. However, sensitivity analysis including 3 high quality studies revealed equal incidence of bladder perforations. Need for blood transfusion was similar in the two groups but fall in hemoglobin was significantly lower in bipolar group (MD − 0.45 CI [− 0.72, − 0.18], p = 0.0009). Bipolar group was found to have significantly lower incidence of tissue artifacts due to thermal energy on pathological examination (OR 0.27 CI [0.15, 0.47], p < 0.00001).

Conclusions

Bipolar and monopolar devices are equally safe in terms of obturator jerk and bladder perforation. Bipolar group was significantly better as compared to monopolar for hospital stay, catheter duration and fall in hemoglobin; however, the clinical relevance of most of these parameters is little.

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Abbreviations

TURBT:

Transurethral resection of bladder tumors

mTURBT:

Monopolar transurethral resection of bladder tumors

bTURBT:

Bipolar transurethral resection of bladder tumors

TUR:

Transurethral resection

TURP:

Transurethral reception of prostate

RCT:

Randomized controlled trials

PRISMA:

Preferred reporting Items for systematic reviews and meta-analysis

PICO:

Patient/population, intervention, control, outcome

GRADE:

Grading of recommendations, assessment, development and evaluations

NMIBC:

Non-muscle invasive bladder cancers

CAD:

Coronary artery disease

NYHA:

New York Heart Association

MD:

Mean difference

CI:

Confidence interval

OR:

Odds ratio

References

  1. Beer E (1952) Removal of neoplasms of the urinary bladder; a new method, employing high-frequency (oudin) currents through a catheterizing cystoscope. Am J Med 13:542

    Article  CAS  Google Scholar 

  2. Osman Y, Harraz AM (2016) A review comparing experience and results with bipolar versus monopolar resection for treatment of bladder tumors. Curr Urol Rep 17:21

    Article  Google Scholar 

  3. Mamoulakis C, Trompetter M, de la Rosette J (2009) Bipolar transurethral resection of the prostate: the 'golden standard' reclaims its leading position. Curr Opin Urol 19:26

    Article  Google Scholar 

  4. Wang DS, Bird VG, Leonard VY et al (2004) Use of bipolar energy for transurethral resection of bladder tumors: pathologic considerations. J Endourol 18:578

    Article  Google Scholar 

  5. Saini AK, Ahuja A, Seth A et al (2015) Histomorphological features of resected bladder tumors: do energy source makes any difference. Urol Ann 7:466

    Article  CAS  Google Scholar 

  6. Murugavaithianathan P, Devana SK, Mavuduru R et al (2018) Bipolar transurethral resection of bladder tumor provides better tissue for histopathology but has no superior efficacy and safety: a randomized controlled trial. J Endourol Endourol Soc 32:1125

    Article  Google Scholar 

  7. Zhao C, Tang K, Yang H et al (2016) Bipolar versus monopolar transurethral resection of nonmuscle-invasive bladder cancer: a meta-analysis. J Endourol 30:5

    Article  Google Scholar 

  8. Cui Y, Chen H, Liu L et al (2016) Comparing the efficiency and safety of bipolar and monopolar transurethral resection for non-muscle invasive bladder tumors: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech 26:196

    Article  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  Google Scholar 

  10. Higgins JP, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  Google Scholar 

  11. Egger M, Davey Smith G, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629

    Article  CAS  Google Scholar 

  12. Borenstein M, Hedges L, Higgins J et al (2013) Comprehensive meta-analysis version 3. In: Biostat. Englewood

  13. Bolat D, Gunlusoy B, Aydogdu O et al (2018) Comparing the short-term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disease: a prospective, randomized, controlled study. Int Braz J Urol 44:717

    Article  Google Scholar 

  14. Geavlete B, Multescu R, Georgescu D et al (2012) Narrow band imaging cystoscopy and bipolar plasma vaporization for large nonmuscle-invasive bladder tumors–results of a prospective, randomized comparison to the standard approach. Urology 79:846

    Article  Google Scholar 

  15. Hashad MM, Abdeldaeim HM, Moussa A et al (2017) Bipolar vs monopolar resection of bladder tumours of %3e3 cm in patients maintained on low-dose aspirin: a randomised clinical trial. Arab J Urol 15:223

    Article  Google Scholar 

  16. Gramann T, Schwab C, Zumstein V et al (2018) Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique-a prospective randomised study. World J Urol 36:1085

    Article  CAS  Google Scholar 

  17. Teoh JC, Chan EY, Yip SY et al (2016) Comparison of detrusor muscle sampling rate in monopolar and bipolar transurethral resection of bladder tumor: a randomized trial. Ann Surg Oncol:1

  18. Del Rosso A, Pace G, Masciovecchio S et al (2013) Plasmakinetic bipolar versus monopolar transurethral resection of non-muscle invasive bladder cancer: a single center randomized controlled trial. Int J Urol 20:399

    Article  Google Scholar 

  19. Venkatramani V, Panda A, Manojkumar R et al (2014) Monopolar versus bipolar transurethral resection of bladder tumors: a single center, parallel arm, randomized, controlled trial. J Urol 191:1703

    Article  Google Scholar 

  20. Sugihara T, Yasunaga H, Horiguchi H et al (2014) Comparison of perioperative outcomes including severe bladder injury between monopolar and bipolar transurethral resection of bladder tumors: a population based comparison. J Urol 192:1355

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Advance Urology Centre (B Block, Level II), PGIMER, Nehru Hospital Building, Chandigarh, 160012, India

    Gopal Sharma, Aditya Prakash Sharma, Ravimohan S. Mavuduru, Girdhar Singh Bora, Sudheer K. Devana, Shrawan K. Singh & Arup K. Mandal

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  1. Gopal Sharma
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  2. Aditya Prakash Sharma
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  3. Ravimohan S. Mavuduru
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  4. Girdhar Singh Bora
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  5. Sudheer K. Devana
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  6. Shrawan K. Singh
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  7. Arup K. Mandal
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Contributions

GS: Protocol development, data collection and management, data analysis and Manuscript writing. AP Sharma: Protocol development, data collection and management, data analysis and Manuscript writing. RS Mavuduru: Data analysis and Manuscript writing and editing. SK Devana: Data analysis and Manuscript writing and editing. G S Bora: Manuscript writing and editing. S K Singh: Manuscript editing. A K Mandal: Manuscript editing.

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Correspondence to Aditya Prakash Sharma.

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Sharma, G., Sharma, A.P., Mavuduru, R.S. et al. Safety and efficacy of bipolar versus monopolar transurethral resection of bladder tumor: a systematic review and meta-analysis. World J Urol 39, 377–387 (2021). https://doi.org/10.1007/s00345-020-03201-3

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  • DOI: https://doi.org/10.1007/s00345-020-03201-3

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