Holmium laser en‑bloc vs bipolar and conventional monopolar TURBT for non‑muscle‑ınvasive bladder cancer.

PURPOSE: This study aimed to compare the clinical safety, surgical efficacy, and oncologic outcomes of three transurethral resection techniques: the conventional monopolar transurethral resection of bladder tumor (CM-TURBT), the bipolar transurethral resection of bladder tumor (BP-TURBT), and the holmium laser en bloc resection of bladder tumor (HoL-ERBT) in patients with primary non-muscle-invasive bladder cancer (NMIBC).

METHODS

This retrospective single-center cohort study included consecutive patients with primary NMIBC treated between January 2020 and March 2025. All eligible patients undergoing CM-TURBT, BP-TURBT, or HoL-ERBT were analyzed. To minimize confounding related to non-random treatment allocation, the inverse probability of treatment weighting (IPTW) based on propensity scores was applied. Perioperative outcomes, complication rates, detrusor muscle inclusion, visible complete resection, and recurrence-free survival (RFS) were compared using weighted analyses. Time-to-event outcomes were assessed with IPTW-adjusted Kaplan-Meier curves and Cox regression models.

RESULTS

After IPTW adjustment, HoL-ERBT was associated with significantly shorter resection times, lower hematuria rates, and reduced catheterization and hospitalization durations compared with CM-TURBT (p < 0.001 for all), while BP-TURBT demonstrated intermediate outcomes. Detrusor muscle inclusion was highest with HoL-ERBT (approximately 93%), compared with CM-TURBT (≈ 66%) and BP-TURBT (≈ 77%). IPTW-adjusted RFS at 12, 24, and 36 months did not differ significantly among the techniques.

CONCLUSION

HoL-ERBT provides meaningful perioperative and pathological advantages over conventional TURBT techniques in NMIBC without compromising short- to mid-term oncologic outcomes. To our knowledge, this is the first study with a follow-up period exceeding 24 months. Despite procedural advantages, similar recurrence outcomes suggest that further prospective randomized trials are warranted to clarify the long-term oncologic role of HoL-ERBT.