Korean J Urol.  2011 Jun;52(6):379-383.

Comparison of Deep Biopsy Tissue Damage from Transurethral Resection of Bladder Tumors between Bipolar and Monopolar Devices

• Yang SJ
• Song PH
• Kim HT

Abstract

PURPOSE
Bipolar energy has recently been used for transurethral resection of bladder tumor (TURBT). Although this modality is thought to be safe, there are some controversies concerning the pathologic accuracy of the biopsy specimens. We compared clinical efficacy, safety, and pathologic characteristics of deep biopsy specimens between bipolar and monopolar devices.
MATERIALS AND METHODS
From January 2002 to June 2007, a total of 115 patients underwent TURBT with deep biopsy with the use of bipolar (bipolar group, n=64) or monopolar (monopolar group, n=51) devices. We retrospectively analyzed tumor size, tumor number, urine cytology, perioperative blood loss (postoperative changes in hemoglobin levels), complications, duration of catheterization, duration of hospitalization, pathologic stage, WHO grade, deep biopsy specimen thickness, and grade of thermal damage.
RESULTS
There were no statistical differences in tumor size, tumor number, urine cytology, complications, duration of hospitalization, pathologic stage, or WHO grade between the two groups. Postoperative changes in hemoglobin levels were significantly lower in the bipolar group (p=0.038), and the duration of catheterization was shorter in the bipolar group (p=0.026). The deep biopsy specimen thickness was significantly thinner in the bipolar group (2.25+/-0.94 mm vs. 3.02+/-1.39 mm, p<0.05). The grade of thermal damage was not statistically different between the two groups (p=0.862).
CONCLUSIONS
In terms of clinical efficacy and safety, bipolar TURBT is comparable to monopolar TURBT, having advantages in perioperative blood loss and duration of catheterization. In addition, pathologic changes in deep biopsy after bipolar and monopolar TURBT are similar. Bipolar TURBT can be properly used for bladder tumors without pathologic error.

Keyword

Artifacts; Surgical pathology; Urinary bladder neoplasms

MeSH Terms

Artifacts
Biopsy
Catheterization
Catheters
Hemoglobins
Hospitalization
Humans
Pathology, Surgical
Retrospective Studies
Urinary Bladder
Urinary Bladder Neoplasms
Hemoglobins

Figure

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  FIG. 1 Thermal damage seen with monopolar and bipolar cautery. (A) Grade I: cautery artifacts involving less than 1/3 of the entire specimen. (B) Grade 2: cautery artifacts involving 1/3 to 2/3 of the specimen. (C) Grade 3: cautery artifacts involving over 2/3 of the specimen.

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  FIG. 2 Comparisons of pathologic stage and WHO grade between the monopolar and bipolar groups. (A) Distribution of pathologic stage (p=0.521). (B) Distribution of WHO grade (p=0.168).

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  FIG. 3 Comparisons of deep biopsy tissue characteristics. (A) Specimen thickness of deep biopsy (3.02±1.39 mm vs. 2.25±0.94 mm, a: p<0.001 by Student's t-test). (B) Grade of thermal damage (p=0.862).

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