Comparison of outcome of conventional bipolar vs. laser en bloc transurethral resection of bladder tumor: A prospective study

Background: Urothelial carcinoma of bladder (UBC) is the second-most common urological malignancy and represents a growing healthcare problem worldwide. Although the vast majority of newly diagnosed bladder cancers are for nonmuscle-invasive disease and may be treated with endourological procedures, correct initial staging is critical. The quality of transurethral resection of bladder tumors (TURBT) strongly determines patient prognosis and overall UBC treatment costs Goals of new strategies should include avoiding second TURBTs and lowering overall treatment regimens. Aims and Objectives: To compare the safety, efficacy, and outcome of conventional bipolar and laser en bloc resection of bladder tumors in nonmuscle-invasive bladder cancer. Materials and Methods: This is a prospective study. The study period will be from January 2023 to May 2024. The study is proposed to be conducted in the Department of Urology, R.G. Kar Medical College and Hospital.101 patients were included in this study. Results: Tumor sizes were nearly similar in both groups (mean 2.1 cm). The higher number of patients had detrusor muscle in their specimen (46 [90.2%]) in the laser group compared to the bipolar group (30 [60.0%]) (P=0.0004). 10 (20.0%) patients had obturator nerve reflex in bipolar group and none in the laser group. A statistically significant (P<0.0001) increase in operative time was observed in bipolar group (43.1000±13.3589.) compared to the laser group (33.5294±7.2315). Hospital stay was higher in the bipolar group (2.3200±0.8437) compared to the laser group (2.1373±0.3475). 10 (20.0%) patients had recurrence in the bipolar group compared to the laser group (8 [15.7%]). Conclusion: The laser en bloc TURBT demonstrated superior advantages in terms of reduced intraoperative bleeding, shorter catheterization time, quicker postoperative recovery, and decreased risk of obturator nerve reflex, thereby decreasing the risk of bladder perforation and higher detrusor muscle acquisition rate, thereby decreasing the need for restage TURBT as compared to the conventional bipolar technique. In addition, the en bloc approach with laser minimized tumor fragmentation, potentially reducing the risk of residual tumor cells and recurrence.