Comparison of clinicopathologic and oncological outcomes between Trans-Urethral En Bloc (TUEB) Resection and Conventional Trans-Urethral Resection of Bladder Tumor (cTURBT): a systematic review, meta-analysis and network meta-analysis with focus on Differ

It has been hypothesized that transurethral en bloc resection of bladder tumor (TUEB) offers benefits over conventional transurethral resection of bladder tumor (cTURBT). This study aimed to compare disease outcomes of TUEB and cTURBT with focus on the different energy sources.

A systematic search was performed using PubMed and Web of Science databases in June 2021. Studies that compared the pathological (detrusor muscle presence), oncological (recurrence rates) efficacy, and safety (serious adverse events ([SAEs]) of TUEB and cTURBT were included. Random- and fixed-effects meta-analytic models and Bayesian approach in the network meta-analysis was used.

Seven randomized clinical trials (RCT) and seven non-RCTs (NRCT), with a total of 2,092 patients. The pooled 3- and 12-month recurrence risk ratio (RR) of five and four NRCTs were 0.46 (95% CI; 0.29- 0.73) and 0.56 (95% CI; 0.33- 0.96), respectively. The pooled 3- and 12-month recurrence risk RRs of four and seven RCTs were 0.57 (95% CI; 0.25- 1.27) and 0.89 (95% CI; 0.69- 1.15), respectively. The pooled RR for SAEs such as prolonged hematuria and bladder perforation of seven RCTs was 0.16 (95% CI; 0.06- 0.41) in benefit of TUEB. Seven RCTs (n= 1077) met our eligibility criteria for network meta-analysis. There was no difference in 12-month recurrence rates between hybridknife, laser, and bipolar TUEB compared to cTURBT. Contrary, laser TUEB was significantly associated with lower SAEs compared to cTURBT. SUCRA ranking analyses showed with high certainty that laser TUEB was the best treatment option to access all endpoints.

While NRCTs suggested a recurrence-free benefit to TUEB compared to cTURBT, RCTs failed to confirm this. Conversely, SAEs were consistently and clinically significantly better for TUEB. Network meta-analyses suggested laser TUEB has the best performance compared to other energy sources. These early findings need to be confirmed and expanded upon.

Journal of endourology. 2021 Oct 23 [Epub ahead of print]

Reza Sari Motlagh, Paweł Rajwa, Keiichiro Mori, Ekaterina Laukhtina, Abdulmajeed Aydh, Satoshi Katayama, Takafumi Yanagisawa, Frederik König, Nico C Grossmann, Benjamin Pradere, Hadi Mostafaei, Fahad Quhal, Pierre I Karakiewicz, Marko Babjuk, Shahrokh F Shariat

Medical University of Vienna, 27271, Urology, Bergenstammgasse 9a/8, Vienna, Wien, Austria, 1130; ., Department of Urology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland, Brzóski 42/1, Zabrze, śląskie, Poland, 41-800; ., The Jikei University School of Medicine, Urology, Minato, Tokyo, Japan; ., Medical University of Vienna, 27271, Urology, Währinger Gürtel 18-20, Wien, Austria, 1090., Medical University of Vienna, 27271, Wien, Wien, Austria; ., Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Urology, Shikata-cho, Okayama, Okayama, Japan, 7008558., The Jikei University Kashiwa Hospital, Urology, 163-1 Kashiwashita, Kashiwa, Chiba, Kashiwa, Japan, 277-0004; ., Medical University of Vienna, 27271, Wien, Wien, Austria; ., Medical University of Vienna, 27271, Urology, Währinger Gürtel 18-20, Zurich, Austria, 8091., CHU Tours, Department of urology, 2 boulevard tonnellé, Tours, France, 37000; ., Medical University of Vienna, 27271, Urology, Wien, Austria; ., Medical University of Vienna, 27271, Wien, Austria; ., University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Quebec, Canada., Motol University Hospital, 48359, Praha, Praha, Czech Republic; ., Medical University of Vienna, 27271, Wien, Wien, Austria.

email news signup