SIU 2017: The Long-Term Impact on NMIBC Recurrence within a Matched-Paired, Index-Control Cohort Setting – NBI–Bipolar Plasma Vaporization Hybrid Approach versus the Standard Diagnostic and Therapeutic Management

Lisbon, Portugal ( In this study, the authors assess whether the combination of narrow band imaging (NBI) with white light cystoscopy (WLC) followed by treatment with biopsy and bipolar plasma vaporization (BPV) was better than WLC, resection and traditional monopolar vaporization (MPV). To that effect, they completed a matched-pair, index-control, cohort study of 260 patient, each of which had at least 1 tumor > 3cm. Index patients (n=130) were prospectively enrolled and underwent WLC+NBI, resection and BPV. They were compared to a retrospective cohort of 130 matched patients treated with WLC, resection and MPV. They were matched by EORTC risk of recurrence (low, intermediate, high).

In follow-up, all patients underwent standard re-resection at 4 weeks, followed by 1 year of BCG therapy (protocol uncertain). Routine guideline cystoscopy surveillance was used. Outcomes measured were: intraoperative complications, perioperative outcomes, and oncologic outcomes (identification of tumor on re-resection, recurrence rates). 

* Rates compared but no statistical analysis completed

Intraoperative complications: Lower obturator reflex rates with BPV (8 vs. 31%) and lower bladder perforation with BPV (0.9 vs. 6.4%). No perioperative complications: There was less of a hemoglobin drop, shorter catheterization periods and shorter hospital stay (2.9 vs. 4.2 days) in patients undergoing BVP. 

Oncologic Outcomes: The re-TUR rate of persistent malignancy and the rate of residual tumor at primary resection site were lower with BVP technique. The 1, 2 and 3-year recurrence rates were lower with BVP technique. 

Ultimately, this entire paper was an anecdotal study – unfortunately, the statistical rigor is lacking. Additional, it is unclear what is being tested – NBI or bipolar energy. Two variables makes the results difficult to analyze, as it is unclear which variable is responsible for the outcomes.

Additionally, some of the outcomes are concerning. Hospital LOS 2-4 days for TURBT is too long already. 6% rate of gross perforation seems quite high. Overall, data is inconsistent.

No conclusions can be drawn from this study. More rigorous study design is required with better statistical analysis.

Presented by: Bogdan Geavlete
Affiliation: Saint John Clinical Emergency Hospital, Romania

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal