Comparative effectiveness of en-bloc resection techniques vs. conventional transurethral resection for non-muscle-invasive bladder cancer

A systematic review and meta-analysis

Authors

  • David E. Hinojosa-Gonzalez Scott Department of Urology, Baylor College of Medicine, Houston, TX https://orcid.org/0000-0002-0233-0607
  • Gal Saffati Scott Department of Urology, Baylor College of Medicine, Houston, TX https://orcid.org/0009-0005-3053-5828
  • Troy La Scott Department of Urology, Baylor College of Medicine, Houston, TX
  • Jackson Cathey Duke University School of Medicine, Durham, NC
  • Juan C. Angulo-Lozano Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
  • Gustavo Salgado-Garza Oregon Health and Sciences University, Portland, OR
  • Jonathan Walsh Scott Department of Urology, Baylor College of Medicine, Houston, TX
  • Bailey Slawin McGovern Medical School at UTHealth Houston
  • Shane Kronstedt Scott Department of Urology, Baylor College of Medicine, Houston, TX https://orcid.org/0000-0003-0757-451X
  • Kate Lowrey Scott Department of Urology, Baylor College of Medicine, Houston, TX
  • Jeremy R. Slawin Scott Department of Urology, Baylor College of Medicine, Houston, TX and Michael E. DeBakey VA Medical Center, Houston, TX

DOI:

https://doi.org/10.5489/cuaj.9070

Keywords:

ERBT, cTURBT, Non-muscle invasive bladder cancer, perioperative outcomes

Abstract

INTRODUCTION: Transurethral en-bloc resection of bladder tumor (ERBT) has emerged as an alternate technique to conventional transurethral resection of bladder tumor (cTURBT). While theoretically advantageous, the comparative effectiveness of ERBT across various technical approaches remains unclear. We performed an updated systematic review and metaanalysis to evaluate perioperative, pathologic, and oncologic outcomes of ERBT vs. cTURBT.

METHODS: We systematically searched PubMed, EMBASE, Scopus, and Google Scholar for randomized controlled trials (RCTs) comparing ERBT and cTURBT. The primary outcome was recurrence-free survival (RFS). Secondary outcomes were operative time, complication rates, detrusor muscle presence, and need for repeated resection. Meta-analyses were performed, with subgroup analyses stratified by ERBT technique.

RESULTS: A total of 10 RCTs with 1973 patients (1012 ERBT, 961 cTURBT) were included. Overall data favored ERBT in RFS (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.71-1.01, p=0.07, I2=48%), with bipolar ERBT demonstrating significantly improved RFS (HR 0.51, 95% CI 0.32-0.81, p=0.004). ERBT had longer operative times compared to cTURBT (mean difference 3.52 minutes, 95% CI 1.25-5.80, p=0.001, I2=71%). There were no significant differences in catheter time or hospital stay between groups. ERBT had a nonsignificant lower incidence of bladder perforation (odds ratio [OR] 0.41, 95% CI 0.16-1.04, p=0.06, I2=52%) and obturator nerve reflex (OR 0.27, 95% CI 0.10-0.74, p=0.01, I2=79%) compared to cTURBT. ERBT was not significantly associated with higher detrusor muscle presence (OR 2.08, 95% CI 0.94-4.58, p=0.07, I2=78%).

CONCLUSIONS: ERBT might have oncologic and perioperative benefits, in addition to technical advantages, relative to cTURBT. Variations in resection instruments used impact the consistency of results.

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Published

2025-05-16

How to Cite

Hinojosa-Gonzalez, D. E. ., Saffati, G., La, T., Cathey, J., Angulo-Lozano, J. C., Salgado-Garza, G., … Slawin, J. R. (2025). Comparative effectiveness of en-bloc resection techniques vs. conventional transurethral resection for non-muscle-invasive bladder cancer: A systematic review and meta-analysis. Canadian Urological Association Journal, 19(9), E328–34. https://doi.org/10.5489/cuaj.9070

Issue

Vol. 19 No. 9 (2025): CUAJ September

Section

Review

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