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

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).

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.

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.

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.