Standard transurethral resection versus transurethral laser surgery for bladder cancer: A systematic review and meta-analysis comparing clinical outcomes and complications.

Introduction Transurethral resection of bladder tumour (TURBT) remains the gold standard method of diagnosing and treating non-muscle invasive bladder cancer. Laser resection has been demonstrated as a safe and efficacious alternative, however its mainstream use remains limited. The aim of this review is to comparatively evaluate clinical outcomes of TURBT and laser resection of bladder tumour (LRBT) for bladder cancer. Methods A systematic review of the literature was performed for studies comparing TURBT and LRBT for bladder cancer. Outcome measurements were recurrence rates, complication rates, patient demographics, operative duration and inpatient stay. Meta-analysis was performed using Review Manager 5. Results Twenty studies on 2,621 patients (n = 1,364 for TURBT and n = 1,257 for LRBT) met inclusion criteria. Demographics including age and gender ratio and follow-up period were similar in both groups. Recurrence rates were similar between TURBT and LRBT (29.1% versus 28.2%%, p=0.12). TURBT had a significantly greater obturator kick rate (11.5% versus 0.4%, p<0.0001) and perforation rate (3.7% versus 0.009%, p=<0.0001). In the six studies which reported on presence of detrusor muscle in the specimen, it was significantly greater in the LRBT group (96.6% versus 88.1%, p=0.01). There was no significant different in operative time between the two groups. TURBT was associated with a significantly longer catheter duration (MD 0.98 days shorter in LBRT group; 95% CI, -1.45 to -0.5, p = <0.00001), and length of stay (MD 1.12 days shorter in LRBT group, 95% CI; -1.7 to -0.54, p = 0.0001). Conclusions LRBT for bladder cancer has the benefit of reduced catheter duration, length of stay and perforation without impacting negatively on operation duration, recurrence rates or specimen quality.

Journal of endourology. 2022 Nov 11 [Epub ahead of print]

Niall O'Sullivan, Eoin MacCraith, Hugo C Temperley, Ailish Naughton, Niall Davis

Tallaght University Hospital, 57976, D24, Dublin, Ireland, D24 NR0A; ., Tallaght University Hospital, 57976, Dublin, Dublin, Ireland; ., Tallaght University Hospital, 57976, Dublin, Dublin, Ireland; ., St Vincent's University Hospital, 58038, Dublin, Dublin, Ireland; ., Beaumont Hospital, 57978, Dublin, Ireland; .

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