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 reasons, monopolar and bipolar resection can be achieved. The aim of the initial resection is to eliminate all apparent tumors together with the underlying muscle layer of the urinary bladder.
An important advantage of bipolar electrocautery includes reduced blood loss due to better hemostasis which helps to shorten the perioperative complications and postoperative recovery period such as catheterization time and hospital stay (Mamoulakis et al, 2011).
TURBT has ordinary been performed by utilizing monopolar electrocautery with a cutting loop. Hypotonic irrigation fluids such as 1.5% glycine or water are essential when operating TUR using monopolar electrocautery Excess fluid absorption, particularly during resection of larger bladder tumors, can result in TUR syndrome which is a potentially fatal complication. Bipolar energy was introduced as an energy source for TURBT using isotonic saline as an irrigation fluid (Geavlete et al, 2011).
In elderly patients and patients with cardiac dysfunction or renal impairment, excess fluid absorption can result in increased vascular volume and cardiopulmonary compromise, such as
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congestive heart failure. The capability of resection without the fear of occurrence of complications may permit for more completed resection. Therefore, in patients at high risk the bipolar TURBT may prove to be the method of choice (Gupta et al, 2011).
Differently, bTURBT has used an active and return electrode in close proximity to each other at the tumor tissue level, thus limiting the distance that is required for the electric energy to pass, thus decreasing the dangers for patients, especially those with the implanted pacemakers or implanted cardioverter defibrillators (ICDs) that do not required to be deactivated (Lee et al, 2013).
The standard practice for the implanted pacemakers or the implanted cardioverter defibrillators (ICDs) is to be deactivated before the surgical operations, including transurethral resection because the intraoperative usage of electrocautery, especially the cutting electric current, can lead to electromagnetic interference beyond the surgical field and deactivate the implanted pacemaker or cause the ICD to work inappropriately. In some instances, the patient cannot be able to withstand deactivation of the implanted pacemaker even for the comparatively short duration of transurethral resection, and this can result in a clinical problem. So, the bipolar electrocautery may be used safely in individuals who have implanted pacemakers or ICDs without deactivation of the device. (Lee et al, 2013).
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Transurethral resection using bipolar electrocautery may also be beneficial to avoid the electromagnetic interference with other implanted electrical machines such as cochlear implants, which cannot be deactivated (Lee et al, 2013).
Furthermore, in mTURBT, 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 (Gupta et al, 2011).
The conclusions that can be shown from our present study are that bipolar resection of urinary bladder tumors have little incidence of complications including particularly bleeding, TUR syndrome, obturator reflex and bladder perforation.
Bipolar TURBT is safe and efficacious in the treatment of bladder tumors particularly, when operating on high risk group such as pregnant women, patients with pacemakers, unstable angina, cardiac diseases and patients with reduced pulmonary reserve because it is reported that bipolar resection is more secure than monopolar resection.