الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
TURBT is the gold standard for the diagnosis and treatment of NMIBC. For these purposes, monopolar and bipolar resection can be applied. The aim of the initial resection is to remove all visible tumors along with an underlying muscle layer of the bladder. TURBT has traditionally been performed using monopolar electrocautery with a cutting loop (61).
Bladder tumors characterized by specific features such as their location in places that are difficult to access (bladder dome, anterior bladder wall) or subject to obturator nerve stimulation (lateral bladder walls) as well as their size (larger than 3 cm) particularly imposed the search for surgical improvement (9).
Bipolar electrosurgical techniques gathered increasing acknowledgement during the recent years, providing significant advantages in terms of decreased obturator nerve stimulation rate and bladder wall perforations.
The studies published during the recent years demonstrated the advantages of bipolar resection both in BPH and bladder tumors endoscopic procedures.
Another potential benefit of bipolar cautery for TURBT includes decreased blood loss due to better hemostasis which helps to shorten the perioperative complications and postoperative recovery period such as hospital stay and catheterization time.
Furthermore, in M-TURBT, the active electrode is represented by the resecting loop, and the return electrode is a diathermic pad placed on the patient’s surface so that the energy travels a considerable distance along the body to complete the circuit. Bipolar electrocautery has an added benefit of not requiring a grounding pad, thus eliminating the possibility of skin burns. Differently, B-TURBT has used an active and return electrode in close proximity to each other at the target tissue level, thus limiting the distance that is required for the energy to cross, thus reducing the risks for patients, particularly those with an implanted pacemaker or cardioverter defibrillator that do not need to be deactivated.
Furthermore, bladder tissue obtained from B-TURBT is of the same histologic quality as that obtained from standard M-TURBT and provides the urologist with a reliable and complete diagnosis (11).
A prospective randomized study included patients with newly diagnosed BC who were planned for TURBT at urology department, Menoufia university hospitals from April 2018 and April 2020. These BC cases were randomized into 2 equal groups: B-TURBT and M-TURBT. Each group included 30 patients. All patients underwent a standard investigation protocol.
Bipolar TURBT was performed using bipolar electrosurgical unit (Covidien ForceTriad™ Energy Platform, Minneapolis, USA), which is compatible with Karl Storz® bipolar resectoscope system (Karl Storz, Tuttlingen, Germany). We used the 26 french (Fr) Karl Storz® resectoscope (Karl Storz, Tuttlingen, Germany) with saline irrigation in bipolar; while distilled water in monopolar.
Tumor resection was done in a step by step manner starting from the top till the base. The underlying detrusor muscle was resected separately and biopsies were sent in separate containers for histopathological examination.