Efficacy and safety of bipolar versus monopolar transurethral resection of bladder tumors: A meta-analysis of randomized controlled trials

Context: In the management of bladder tumors bipolarenergy has been used as a common alternative to the conventional monopolar transurethral resection of the bladder (M-TURB). Aim: This study aims to examine the clinical efficacy and safety of bipolar versus monopolar TURB tumors (TURBTs). Subjects and Methods: We conducted a systematic literature search in the PubMed, Cochrane Library, and Embase databases for the identification of prospective randomized controlled trials (RCTs) that compared the outcomes between the two procedures. The Statistical Tool: Meta-analysis was performed using the software Review Manager 5.3. Results: We identified nine RCTs involving 1193 patients. In terms of the surgical outcomes, there was no significant difference between the bipolar and monopolar TURBT. However, there was significantly reduced bladder perforation (risk ratio [RR] = 0.48; 95% confidence interval [CI] = 0.30-0.77; P = 0.002) and shorter hospital stay (mean difference = 0.43; 95% CI = 0.83-0.03, P = 0.01) in the bipolar TURBT group. There was also a lower incidence of thermal damage, which causes histopathological artifacts for patients treated via bipolar TURBT relative to those treated via monopolar TURBT (RR = 0.66; 95% CI = 0.55-0.78; P < 0.00001). P < 0.05 was considered to be statistically significant. However, after bipolar and monopolar TURBT, we had no sufficient evidence regarding the recurrence rate. Conclusion: This meta-analysis suggests that the use of bipolar technology, which is associated with less bladder perforation and lower thermal artifacts in TURBT is safer and more effective.