Monopolar versus bipolar trans-urethral resection of bladder tumors (TURBT) �A single-centre, parallel arm, randomized controlled trial
The aim of our study was to compare the safety and efficacy of bipolar TURBT with monopolar resection.
Materials and Methods:
A single–centre parallel arm randomized controlled trial was conducted from May 2011 to August 2012. All patients with suspected bladder tumours were eligible. Patients refusing consent and those undergoing routine restaging TURBT were excluded.
The primary end–point was the incidence of obturator jerk. Secondary outcomes studied were fall in hematocrit, re–coagulation and transfusion rates, bladder perforation, fall in sodium level, development of TUR syndrome and resection time. Pathological quality was assessed by comparing the presence of deep muscle, and degree of severe cautery artifact in both arms.
A total of 257 TURBT�s were performed during the study period. After exclusion, 147 patients were randomized – 75 in the monopolar arm and 72 in the bipolar arm. There were 6 protocol violation in the monopolar arm and 4 in the bipolar arm. Both intention to treat and per–protocol analyses were performed. The incidence of obturator jerk was greater in the bipolar arm (60% vs 49.2%, p=0.27). There was no significant difference between the secondary outcomes studied. The only significant difference observed was a significantly lower incidence of severe cautery artifact in the bipolar arm (25% vs 46.7%, p=0.0096).
Bipolar TURBT was not superior to monopolar resection with respect to obturator jerk, bladder perforation and hemostasis. There is a significantly lower incidence of severe cautery artifact following bipolar resection.