Evaluation of bipolar transurethral en-bloc resection in patients with primary non-muscle invasive bladder cancer

Background Conventional TURBT includes tumour fragmentation; this impairs pathological examination and is associated with a high risk of residual disease, tumour understaging and early recurrence. En-bloc TURBT (eTURBT) is supposed to overcome these major drawbacks. It includes uprooting of the whole tumour in one piece, providing an intact specimen for accurate pathological evaluation with a low risk of scattering malignant cells. Aim This study aimed to evaluate the efficacy, safety and oncological outcomes of bipolar eTURBT in resection of a small primary bladder mass. Patients and methods This prospective study included 63 patients with a primary bladder mass suspected to be non-muscle invasive bladder cancer (NMIBC). All patients underwent bipolar eTURBT using a mushroom loop electrode. All operations were performed by one experienced uro-oncologist and all the procedures were successfully completed. The patients included were scheduled for follow-up cystoscopy at 3, 6 and 12 months. Results The mean (SD) operative time was 37.01 (±5.50) min, enucleation time was 23.11 (± 6.26) min and obturator nerve jerk occurred only in three cases (4.76%); the mean (SD) postoperative irrigation time was 1.21 (±3.32) h, haemoglobin drop was 0.3 (± 0.57) g/dl, with no need for blood transfusion at all, and the mean (SD) hospital stay was 2.30 (±0.53) days. There were no other perioperative complications. Conclusion Bipolar eTURBT is effective and safe for managing NMIBC as it preserves well-intact specimens, with negligible perioperative complications.