Reza Sari Motlagh1,2, Pawel Rajwa1,3, Keiichiro Mori1,4, Ekaterina Laukhtina1,5, Abdulmajeed Aydh1,6, Satoshi Katayama1,7, Takafumi Yanagisawa1,4, Frederik König1,8, Nico C Grossmann1,9, Benjamin Pradere1, Hadi Mostafai1,10, Fahad Quhal1,11, Pierre I Karakiewicz12, Marek Babjuk1,13, Shahrokh F Shariat1,5,14,15,16,17. 1. Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 2. Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3. Department of Urology, Medical University of Silesia, Zabrze, Poland. 4. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. 5. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. 6. Department of Urology, King Faisal Medical City, Abha, Saudi Arabia. 7. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 8. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Urology, University Hospital Zurich, Zurich, Switzerland. 10. Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 11. Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia. 12. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. 13. Department of Urology, Motol University Hospital, 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic. 14. Department of Urology, Weill Cornell Medical College, New York, New York, USA. 15. Department of Urology, University of Texas Southwestern, Dallas, Texas, USA. 16. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 17. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
Abstract
Introduction: It has been hypothesized that transurethral en bloc (TUEB) of bladder tumor 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. Methods: 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. Results: Seven randomized clinical trials (RCTs) and seven non-RCTs (NRCT), with a total of 2092 patients. The pooled 3- and 12-month recurrence risk ratios (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 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 with cTURBT. Contrary, laser TUEB was significantly associated with lower SAEs compared with cTURBT. Surface under the cumulative ranking curve ranking analyses showed with high certainty that laser TUEB was the best treatment option to access all endpoints. Conclusion: While NRCTs suggested a recurrence-free benefit to TUEB compared with 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 with other energy sources. These early findings need to be confirmed and expanded upon.
Introduction: It has been hypothesized that transurethral en bloc (TUEB) of bladder tumor 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. Methods: 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. Results: Seven randomized clinical trials (RCTs) and seven non-RCTs (NRCT), with a total of 2092 patients. The pooled 3- and 12-month recurrence risk ratios (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 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 with cTURBT. Contrary, laser TUEB was significantly associated with lower SAEs compared with cTURBT. Surface under the cumulative ranking curve ranking analyses showed with high certainty that laser TUEB was the best treatment option to access all endpoints. Conclusion: While NRCTs suggested a recurrence-free benefit to TUEB compared with 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 with other energy sources. These early findings need to be confirmed and expanded upon.
Entities:
Keywords:
TUEB; TURBT; bladder cancer; en bloc; transurethral en bloc; transurethral resection
Authors: Pietro Diana; Andrea Gallioli; Matteo Fontana; Angelo Territo; Alejandra Bravo; Alberto Piana; Michael Baboudjian; Pavel Gavrilov; Óscar Rodriguez-Faba; Josep Maria Gaya; Ferran Algaba; Joan Palou; Alberto Breda Journal: World J Urol Date: 2022-05-31 Impact factor: 3.661