Efficiency of the bipolar technology in NBI in patients with high-risk non-invasive bladder tumors

166 Efficiency of the bipolar technology in NBI in patients with high-risk non-invasive bladder tumors Stanescu F.A., Geavlete B., Moldoveanu C., Jecu M., Ene C., Bulai C., Balan G., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania INTRODUCTION & OBJECTIVES: A retrospective study was performed aiming to evaluate the efficacy of a multi-modal approach consisting in narrow band imaging (NBI) cystoscopy and bipolar technology when compared to the standard protocol represented by white light cystoscopy (WLC) and transurethral resection of bladder tumors (TURBT) in patients with high-risk non-invasive bladder tumors. MATERIAL & METHODS: A total of 80 patients with high risk non-invasive bladder tumors were included in the trial. In the first group, 40 patients underwent conventional and NBI cystoscopy followed by bipolar approach – resection and vaporization. For tumors under 1 cm bipolar “en bloc” resection was applied, between 1 and 3 cm serial bipolar resection and for tumors over 3 cm resection and bipolar plasma vaporization. In a similar number of cases of the second arm, classical WLC and TURBT were applied. In all cases standard monopolar Re-TUR was performed at 4-6 weeks after the initial intervention, followed by one year’ BCG immunotherapy. The follow-up protocol included abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years. RESULTS: The obturator nerve stimulation (5% vs. 17.5%), bladder wall perforation (2.5% vs. 7.5%), mean hemoglobin level drop (0.4 vs. 0.9 g/dl), postoperative bleeding (5% vs. 7.5%), catheterization period (48.2 vs. 74.6 hours) and hospital stay (2.9 vs. 4.1 days) were significantly reduced for the plasma vaporization technique by comparison to conventional resection. Concerning tumoral detection, the present data confirmed the NBI superiority when compared to standard WLC regardless of tumor stage. During standard Re-TUR the overall residual tumors’ rate (5% versus 12,5%) was significantly lower for the NBI-bipolar technology group. The 1 (11.7% vs. 20.7%) and 2 (18.7% versus 29.6%) years’ recurrence rates were substantially lower for the combined approach. CONCLUSIONS: NBI cystoscopy significantly improved diagnostic accuracy, while bipolar technology showed a higher surgical efficiency, lower morbidity and faster postoperative recovery. The combined technique NBI – bipolar approach offered a reduced rate of residual tumors at Re-TUR, as well as a substantially lower recurrence rates at 1 and 2 years. Eur Urol Suppl 2015; 14(6): e1322