Impact of Energy Source on Outcomes in En Bloc TURB of Bladder Tumors

Overview

This secondary analysis of a randomized study evaluated the impact of different energy sources—monopolar, bipolar, and laser—used during en bloc transurethral resection of bladder tumors (ERBT) on pathological quality and perioperative outcomes. The presence of detrusor muscle (DM) in specimens, a key quality marker, was similar across energy modalities, with no significant differences in operative or postoperative complications.

Background

Transurethral resection of bladder tumor (TURB) is the initial treatment step for non-muscle invasive bladder cancer, aiming to remove tumors and provide quality specimens for accurate pathological staging. Conventional TURB often results in fragmented specimens with low detrusor muscle presence, which can lead to understaging and worse prognosis. En bloc resection of bladder tumor (ERBT) has emerged to improve specimen integrity and staging accuracy. Different energy sources can be used for ERBT, but their comparative impact on specimen quality and clinical outcomes remains unclear.

Data Highlights

Key Findings

• Detrusor muscle was present in approximately 81% of patients overall, with no significant difference between monopolar (83%), bipolar (79%), and laser (83%) ERBT groups (p = 0.47).
• ERBT specimens maintained integrity and allowed for precise pathological assessment regardless of energy source.
• Perioperative outcomes, including operation duration, obturator nerve reflex occurrence, bladder perforation, and postoperative complications, showed no significant differences across energy modalities.
• No conversions to conventional TURB were reported in the ERBT cohort.
• Use of enhanced visualization techniques was mandatory, supporting consistent tumor margin identification and resection quality.

Clinical Implications

The choice of energy source for ERBT—monopolar, bipolar, or laser—does not significantly affect the presence of detrusor muscle in resected specimens or perioperative safety outcomes. Surgeons can select the energy modality based on availability and preference without compromising specimen quality or patient safety. ERBT remains a valuable technique to improve pathological staging accuracy in non-muscle invasive bladder cancer.

Conclusion

This analysis demonstrates that different energy sources used during ERBT yield comparable specimen quality and perioperative outcomes, supporting the flexibility of energy modality choice in clinical practice. ERBT continues to enhance pathological assessment and may improve bladder cancer management.

References

1. ClinicalTrials.gov NCT03718754 -- Original randomized study on ERBT vs cTURB
2. WHO 1973 and WHO 2004 classifications -- Pathological grading standards