Two-step enucleation combined with needle electrode: a modified TURBT technique to enhance detrusor muscle detection

To evaluate the safety and efficacy of a modified two-step needle-electrode enucleation technique for improving detrusor muscle (DM) detection in transurethral resection of bladder tumor (TURBT).

This retrospective study included 103 patients undergoing bipolar TURBT between 2019 and 2023, assigned to Two-step enucleation (n = 37), En bloc enucleation (n = 32), or Conventional TURBT (cTURBT) (n = 34). Inverse probability of treatment weighting (IPTW) was applied to mitigate selection bias. Weighted comparisons used survey-design-adjusted methods, including Rao-Scott chi-square tests and weighted regression models. Outcomes included DM detection, operation time, complications, recovery metrics, and short-term recurrence.

After IPTW, the Two-Step group demonstrated a higher DM detection rate than the cTURBT group (95.8% vs. 69.4%; adjusted p = 0.03), with an odds ratio of 12.40 (95%CI 1.17-131.92; p = 0.04). No significant difference was observed between the Two-Step and En bloc groups. The Two-Step procedure required a longer operation time than En bloc enucleation (27.7% increase; 95% CI 3.1-58.2%; p = 0.03) and was associated with a longer hospital stay than cTURBT (16.6% increase; 95% CI 2.9-32.2%; p = 0.02). No other statistically significant differences were found among the three groups.

Two-step enucleation with a needle electrode improves DM detection compared with cTURBT. The procedure time is slightly longer than that of En bloc enucleation. Larger prospective studies are warranted to validate these findings, the perioperative safety, and the long-term oncological outcomes.