title: Comparison of perioperative outcomes including severe bladder injury between monopolar and bipolar transurethral resection of bladder tumors: a population based comparison.
abstract: OBJECTIVE
  In this study we used nationwide population based data to compare perioperative outcomes, including severe bladder injury, between monopolar and bipolar transurethral resection of bladder tumors.
  
  
  METHODS
  Data of patients with clinical T2 or less bladder cancer who underwent monopolar or bipolar transurethral bladder tumor resection were collected from 788 hospitals in the Japanese Diagnosis Procedure Combination database 2007-2012. One-to-one propensity score matching was performed. End points assessed were severe bladder injury requiring placement of a drainage tube or repair surgery within 3 postoperative days, hemostasis procedures consisting of clot removal or transurethral coagulation within 3 postoperative days, transfusion, other complications, anesthesia duration, postoperative length of stay and total costs. Multivariate analyses compared outcomes of bipolar and monopolar transurethral bladder tumor resection with gender, age, Charlson comorbidity index, clinical stage, hospital volume and hospital academic status as covariates.
  
  
  RESULTS
  A total of 8,188 pairs were generated. Compared with monopolar transurethral bladder tumor resection, bipolar resection was associated with a significantly lower incidence of severe bladder injury (0.3% vs 0.6%, OR 0.57), other complications (4.6% vs 5.8%, OR 0.78), slightly shorter postoperative stay (mean 6.4 vs 6.7 days, difference -3.3%) and slightly lower total costs (mean $4,628 vs $4,727; difference -1.1%, all p <0.05). There were no differences in postoperative hemostasis procedures, transfusion and anesthesia duration.
  
  
  CONCLUSIONS
  Bipolar transurethral bladder tumor resection was associated with a substantially lower incidence of several perioperative complications including severe bladder injury. The findings support the benefit of bipolar transurethral bladder tumor resection over monopolar resection in real-world clinical practice.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Urology, University of Tokyo, Tokyo, Japan. Electronic address: ezy04707@nifty.com.
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Urology, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.affiliation: Department of Urology, University of Tokyo, Tokyo, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: Department of Urology, University of Tokyo, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014513:Ureter; D001743:Urinary Bladder / Q000293:injuries*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001749:Urinary Bladder Neoplasms / Q000601:surgery
keywords: electrocoagulation; outcome assessment; postoperative complications; urinary bladder neoplasms