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

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 literatu...

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Bibliographic Details
Published in:World journal of urology 2021-02, Vol.39 (2), p.377-387
Main Authors: Sharma, Gopal, Sharma, Aditya Prakash, Mavuduru, Ravimohan S., Bora, Girdhar Singh, Devana, Sudheer K., Singh, Shrawan K., Mandal, Arup K.
Format: Article
Language:English
Subjects:
Bladder
Bladder cancer
Blood transfusion
Catheters
Hemoglobin
Medicine
Medicine & Public Health
Meta-analysis
Nephrology
Oncology
Original Article
Patients
Sensitivity analysis
Urology
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Summary: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  
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-020-03201-3