Bipolar vs monopolar resection of bladder tumours of >3 cm in patients maintained on low-dose aspirin: A randomised clinical trial

Abstract

ObjectiveTo compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm.Patients and methodsA prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT). The primary endpoint of the study was the decrease in postoperative haemoglobin (Hb) concentration measured using an automated cell counter. The secondary endpoints of the study were intraoperative blood transfusion or the occurrence of urethral trauma during cystoscopy and the need for re-coagulation.ResultsThe postoperative reduction in Hb concentration, was significantly lower in the B-TURBT group [mean (SD) 0.55 (0.26) g/dL] compared with the M-TURBT group [mean (SD) 1.24 (0.61) g/dL] (P < 0.001). There was also a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit and the mean postoperative hospital stay. There was no significant difference between the groups for the occurrence of obturator jerk, bladder perforation, and the need for blood transfusion.ConclusionB-TURBT in patients maintained on low-dose aspirin is better than M-TURBT for minimising postoperative drop in Hb concentration.

Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

“…Del Rosso et al [7] in a randomised clinical trial showed a significant reduction in the mean (range) hospitalisation time with B-TURBT at 2.2 (2-7) days vs 3.5 (3-6) days in the M-TURBT group (P = 0.008). Hashad et al [20] also reported a significant difference in the mean (SD) postoperative hospital stay in favour of B-TURBT at 31.20 (11.57) vs 42.24 (15.67) h for M-TURBT (P < 0.001) [20]. In our present study, the hospital time was also shorter in the B-TURBT group at 1 day vs the M-TURBT group at 2 days.…”

“…Comparable results were obtained by Del Rosso et al [7], whereby bladder perforation was reported in two cases in the monopolar arm and in none in the bipolar arm, with no statistically difference between the groups. Hashad et al [20] also reported bladder perforation in four patients in their monopolar arm and in one patient in the bipolar arm, with no statistical difference between the groups (P = 0.369). Mashni et al [21] reported that no patients developed bladder perforation, with no statistically difference between the groups.…”

“…Yang et al [25] reported a significant drop in Hb level with M-TURBT vs B-TURBT, which was not reflected in the transfusion rate. Also, Hashad et al [20] reported that the postoperative reduction in Hb concentration was significantly lower in the B-TURBT group vs the M-TURBT group (P < 0.001). There was a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit but there was no significant difference between the groups in requirement for blood transfusion.…”

“…In our present study, obturator reflex was higher in the M-TURBT group, affecting 10 patients (25%) vs two (5%) in the B-TURBT group, which was statistically significant (P = 0.025). Mashni et al [21], Hashad et al [20], Del Rosso et al [7] and Liem et al [5] reported equal incidence between both techniques, at 4 vs 4, 15 vs 12, 1 vs 1, and 22 vs 25, respectively. The Xishuang et al [16] report favoured B-TURBT in abolishing the obturator reflex in a statistically significant way compared with M-TURBT.…”

“…Better control of intraoperative bleeding allows for a shorter postoperative period of catheterisation with a subsequently faster discharge [7]; also, the present results show shorter hospitalisation duration for B-TURBT. There is universal agreement that the use of bipolar resection decreases the hospital stay [7,16,20,22], as with bipolar current there is the more efficient property of bipolar resection in cutting and simultaneously controlling bleeding, when compared with the monopolar procedure [26]. On the other hand Liem et al [5] found no statistically significant difference between the groups.…”