Introduction and Objective: Conventional Transurethral resection of bladder tumor (TURBT), using unipolar electroresection, is the gold standard procedure for staging and treatment of Non-muscle Invasive Bladder Cancer (NMIBC). However, it may be associated with dilutional hyponatremia, obturator nerve stimulation with subsequent bladder perforation, and high rate of recurrence. The aim of this study was to assess the efficacy and safety of a novel technique using bipolar plasma kinetic energy for en block enucleation of NMIBC.
Patients and Methods: Between February 2012 and June 2013, patients diagnosed with suspected NMIBC in a tertiary referral centre were prospectively recruited for a novel technique of transurethral Bi-polar Plasma Kinetic Enucleation of Bladder Tumour (PKEBT). Patients with tumour size >30 mm and those with >2 masses were excluded. The technique was performed using the Button loop and the HF Unit UES-40 Surgmaster (Olympus). Within 6 hours post-operatively, all patients received a single dose of intravesical Mitomycin-C through tri-way indwelling urethral catheter. One month postoperatively, repeat Bi-polar TURBT was performed for resection of any residual tumour. Furthermore, intravesical immunotherapy was introduced according to the pathology results. Follow-up diagnostic cystoscopy was performed at 3, 6, and 12 months. Baseline demographic characteristics and perioperative data were reported.
Results: A total of 46 patients underwent transurethral bipolar PKEBT. All procedures were successfully completed. Seventy eight percent of patients were male, with mean age of 62.7±8.5 years, mean tumour size of 17.8±6.1 mm, mean enucleation time of 17±5.4 minutes, mean operative time of 27.9±11.4 minutes and mean hospital stay of 35.4±13 hours. Three procedures were associated with intra-operative bleeding that necessitated blood transfusion. There were no other reported perioperative complications. One month post-operatively, 6 (13%) cases were diagnosed with residual tumour and had undergone Repeat Bi-polar TURBT. The overall recurrence rate at 12 months follow-up was 15.2%.
Conclusions: Bi-polar PKEBT seems to be safe and effective technique for management of NMIBC.
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