Comparison of Detrusor Muscle Sampling Rate in Monopolar and Bipolar Transurethral Resection of Bladder Tumor: A Randomized Trial

• Published in: Annals of surgical oncology 2017-05, Vol.24 (5), p.1428-1434
• Main Authors: Teoh, Jeremy Yuen-Chun, Chan, Eddie Shu-Yin, Yip, Siu-Ying, Tam, Ho-Man, Chiu, Peter Ka-Fung, Yee, Chi-Hang, Wong, Hon-Ming, Chan, Chi-Kwok, Hou, Simon See-Ming, Ng, Chi-Fai
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Electrosurgery - adverse effects; Electrosurgery - instrumentation; Electrosurgery - methods; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Muscle, Smooth - pathology; Muscle, Smooth - surgery; Oncology; Prospective Studies; Sex Factors; Surgery; Surgical Oncology; Tumor Burden; Urinary Bladder - pathology; Urinary Bladder - surgery; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urologic Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5700-7

Purpose Our aim was to investigate the detrusor muscle sampling rate after monopolar versus bipolar transurethral resection of bladder tumor (TURBT). Methods This was a single-center, prospective, randomized, phase III trial on monopolar versus bipolar TURBT. Baseline patient characteristics, disease characteristics and perioperative outcomes were compared, with the primary outcome being the detrusor muscle sampling rate in the TURBT specimen. Multivariate logistic regression analyses on detrusor muscle sampling were performed. Results From May 2012 to December 2015, a total of 160 patients with similar baseline characteristics were randomized to receive monopolar or bipolar TURBT. Fewer patients in the bipolar TURBT group required postoperative irrigation than patients in the monopolar TURBT group (18.7 vs. 43%; p  = 0.001). In the whole cohort, no significant difference in the detrusor muscle sampling rates was observed between the bipolar and monopolar TURBT groups (77.3 vs. 63.3%; p  = 0.057). In patients with urothelial carcinoma, bipolar TURBT achieved a higher detrusor muscle sampling rate than monopolar TURBT (84.6 vs. 67.7%; p  = 0.025). On multivariate analyses, bipolar TURBT (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.03–4.81; p  = 0.042) and larger tumor size (OR 1.04, 95% CI 1.01–1.08; p  = 0.022) were significantly associated with detrusor muscle sampling in the whole cohort. In addition, bipolar TURBT (OR 2.88, 95% CI 1.10–7.53; p  = 0.031), larger tumor size (OR 1.05, 95% CI 1.01–1.10; p  = 0.035), and female sex (OR 3.25, 95% CI 1.10–9.59; p  = 0.033) were significantly associated with detrusor muscle sampling in patients with urothelial carcinoma. Conclusions There was a trend towards a superior detrusor muscle sampling rate after bipolar TURBT. Further studies are needed to determine its implications on disease recurrence and progression.