Bipolar Transurethral En Bloc Resection in Patients with Non-Muscle-Invasive Bladder Cancer: A Pilot Retrospective Study

Introduction . Conventional transurethral resection of bladder tumor (TURBT) carries risks of tumor fragmentation, cell dissemination, and resection artifacts impairing staging. En bloc resection (ERBT) overcomes these limitations, but the safety, staging accuracy, and oncological efficacy of loop bipolar ERBT during the learning curve require clarification. Purpose of the work is to evaluate histopathological specimen quality, perioperative safety, and oncological outcomes of loop bipolar ERBT in patients with non-muscle-invasive bladder cancer (NMIBC). Materials and Methods. This two-center retrospective study enrolled 38 NMIBC patients (cTa–T1N0M0; median age 64.5 years) treated with loop bipolar ERBT by four surgeons. Most cases had solitary lesions (84.2 %) with a median size of 1.5 cm on lateral walls (68.4 %). Specimen quality, complications (Clavien–Dindo), and recurrence-free survival (RFS) in 33 patients with pTa–T1 urothelial carcinoma were evaluated. Results . Detrusor muscle was present in 68.4 % (26/38) of specimens, and R0 resection was achieved in 100 % of cases. Pathological stages were pTa (71.1 %), pT1 (15.8 %), pT2a (5.3 %), and PUNLMP (7.9 %); 89.5 % were lowgrade. Obturator nerve reflex occurred in 7.9 % (3/38) of cases, extraperitoneal microperforations (Clavien–Dindo grade I) occurred in 7.9 % (3/38); all resolved with conservative management. At a median follow-up of 24.0 months, recurrence developed in 18.2 % (6/33) outside the resection site. The 1‑and 3‑year RFS rates were 93.5 % (95 % CI 84.8–100.0 %) and 78.9 % (95 % CI 63.8–94.0 %), with no muscle-invasive progression. Conclusion . Loop bipolar ERBT provides reliable staging, a manageable safety profile, and satisfactory oncological outcomes using standard equipment during the initial adoption phase.