Introduction: A prospective, randomized, long term comparison between narrow band imaging (NBI) cystoscopy and bipolar plasma vaporization (BPV) versus standard white light cystoscopy (WLC) and monopolar transurethral resection of bladder tumors (TURBT) was performed.
Methods: A total of 220 patients with at least one apparently non-muscle invasive bladder tumor (NMIBT) over 3 cm were included in the trial based on abdominal ultrasound, computer tomography and flexible WLC. In one arm, 110 patients underwent WLC, NBI cystoscopy and BPV, while cases in the second arm only benefited from WLC and TURBT. Standard monopolar Re-TUR at 4 weeks was applied in all NMIBT cases. The follow-up protocol included abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years.
Results: In the NBI-BPV series, the CIS (94.6% versus 67.6%), pTa (93% versus 82.4%) and overall NMIBT (94.9% versus 84.3%) detection rates were significantly improved for NBI cystoscopy by comparison to WLC. NBI diagnosed significantly more cases of additional tumors (30.5% versus 9.5%). The obturator nerve stimulation (3.2% versus 18.6%), bladder wall perforation (1.1% versus 7.2%), mean hemoglobin drop (0.2 g/dl versus 0.9 g/dl) and postoperative bleeding (1.1% versus 6.2%) rates were significantly reduced for BPV. The catheterization period and hospital stay were significantly shorter subsequent to BPV. The overall (6.3% versus 17.5%) and primary site (4.2% versus 13.4%) Re-TUR residual tumors’ rates were significantly lower for NBI-BPV. The 1 (6.9% versus 16.8%) and 2 (11.5% versus 25.8%) years’ recurrence rates were significantly reduced in the NBI-BPV group.
Conclusions: NBI cystoscopy displayed significantly improved diagnostic accuracy and BPV emphasized superior efficacy, reduced morbidity and faster postoperative recovery in large NMIBT cases. The NBI-BPV technique provided a lower Re-TUR residual tumors’ rate as well as reduced 1 and 2 years’ recurrence rates by comparison to the standard approach.