Bipolar plasma en-block resection versus standard monopolar TURBT in selected NMIBT cases – A prospective, randomized-controlled, medium term study
GeavleteB.a,b, Ene C.a,b, Bulai C.a, Balan G.a, Moldoveanu C.a, Geavlete P.a,b
a-“Saint John” Clinical Emergency Hospital, Department of Urology, Bucharest, Romania; b-University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania;
Introduction: The trial was aimed to evaluate a novel bladder cancer ablation technique (bipolar plasma en-block resection – BPER and tumor bed biopsy resection) and to compare it to the standard monopolar transurethral resection of bladder tumors (TURBT) while applying it in selected cases of suspected papillary non-muscle invasive bladder tumors (NMIBT).
Material and methods: A prospective, randomized-controlled, medium term study enrolled 140 consecutive patients diagnosed with at least 1 papillary bladder tumor of 1–3 cm diameter based on abdominal ultrasound and contrast CT. Patients of the study arm (n=70) underwent BPER (completed by bipolar biopsy resection of the tumor bed area). In cases of the control series (n=70), conventional monopolar TURBT was exclusively used. In all pathologically confirmed NMIBT cases, the follow-up protocol included abdominal ultrasound, urinary cytology and cystoscopy, performed every 3 months for a period of one year. Muscle invasive bladder cancer cases and patients missing periodical check-ups were excluded from the trial.
Results: When compared to TURBT, the BPER procedure was characterized by significantly reduced surgical time (18.34 versus 25.93 minutes), mean hemoglobin level drop (0.41 versus 0.76 g/dl), catheterization period (1.58 versus 2.47 days) and hospital stay (2.09 versus 3.52 days). Detrusor muscle tissue was present in the resected specimens for all enrolled cases. A total of 61 and respectively 63 NMIBT cases in the 2 study groups completed the follow-up protocol. A significantly lower bladder cancer recurrence rate was emphasized during the 12 months’ follow-up period among patients of the study arm by comparison to the control series (9.8% versus 17.5%). The difference relied on the significantly decreased frequency of other site recurrences (from the initial lesions) displayed in the BPER cohort (6.6% versus 12.7%).
Conclusions: The BPER procedure emphasized superior surgical efficiency, reduced perioperative bleeding and faster postoperative recovery. A significant benefit was obtained in terms of oncologic outcome during medium term follow-up, as substantially fewer new site recurrences were found subsequent to en-block resection when compared to standard TURBT.