Comparative Analysis of En-Bloc and Conventional Transurethral Resection of Bladder Tumor (TURBT) for Non-Muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

Reynaldo Reynaldo(1*), Richard Arie Monoarfa(2), Diki Arma Duha(3)
(1) Medical Practitioner, Toto Kabila Hospital, Gorontalo
(2) Department of Urology, Toto Kabila Hospital, Gorontalo
(3) Department of Urology, Toto Kabila Hospital, Gorontalo
(*) Corresponding Author
DOI : 10.30604/jika.v9i1.2285


In order to treat non-muscle invasive bladder cancer, this study will compare and contrast conventional transurethral resection of bladder tumors (TURBT) with En-bloc resection (ERBT). It will also assess the efficacy, safety, and recurrence rates of these two methods. We searched PubMed and Sience Direct for relevant articles published between 2013 and 2023. Articles from randomized controlled trials, retrospective analyses, and prospective studies comparing non-muscle invasive bladder cancer therapies employing en bloc versus conventional TURBT are included in this analysis. Measuring effect size was done using Mean Difference (MD) and Odd Ratio (OR) with 95% CI. There is statistical significance when the p-value is less than 0.05. Fourteen studies were eligible for inclusion. With fewer tumor recurrences (OR 0.66; 95% [CI]  0.52, 0.84; I2 = 6%; P = 0.0007), ERBT proved to be superior to TURBT. There was a decrease in the occurrence of perioperative complications and outcomes associated with ERBT, including bladder perforation and obturator nerve injury.  According to the fourteen articles that were included, patients receiving ERBT experienced much fewer complications, recurrences, hospital stays, and catheterization time than those receiving conventional TURBT.


Bladder Cancer; ERBT; TURBT; NMIBC


Asfour, V., Gibbs, K., DaSilva, A. S., Fernando, R., Digesu, G. A., & Khullar, V. (2019). Validation study of ultrasound bladder wall thickness measurements. International Urogynecology Journal, 30(9), 1575–1580.

Badawy, A., Sultan, S., Marzouk, A., & El-Sherif, E. (2023). Thulium laser en bloc resection versus conventional transurethral resection of urinary bladder tumor: A comparative prospective study. Urology Annals, 15(1), 88–94.

Chen, J., Zhao, Y., Wang, S., Jin, X., Sun, P., Zhang, L., & Wang, M. (2016). Green-light laser en bloc resection for primary non-muscle-invasive bladder tumor versus transurethral electroresection: A prospective, nonrandomized two-center trial with 36-month follow-up. Lasers in Surgery and Medicine, 48(9), 859–865.

Chen, X., Liao, J., Chen, L., Qiu, S., Mo, C., Mao, X., Yang, Y., Zhou, S., & Chen, J. (2015). En bloc transurethral resection with 2-micron continuous-wave laser for primary non-muscle-invasive bladder cancer: a randomized controlled trial. World Journal of Urology, 33(7), 989–995.

Di, Y. C., Li, H. W., He, C. Y., & Peng, H. L. (2023). En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis. Actas Urologicas Espanolas, 47(5), 309–316.

D’Souza, N., & Verma, A. (2016). Holmium laser transurethral resection of bladder tumor: Our experience. Urology Annals, 8(4), 439–443.

Ferlay, J., Ervik, M., Lam, F., Laversanne, M., Colombert, M., Mery, L., Pineros, M., Znaor, A., Soerjomataram, I., & Bray, F. (2024). Global Cancer Observatory: Cancer Today.

Gontero P. (2023). EAU Guideline on Non-muscle-invasive Bladder Cancer (TaT1 and CIS).

Hashem, A., Mosbah, A., El-Tabey, N. A., Laymon, M., Ibrahiem, E. H., Elhamid, M. A., & Elshal, A. M. (2021). Holmium Laser En-bloc Resection Versus Conventional Transurethral Resection of Bladder Tumors for Treatment of Non–muscle-invasive Bladder Cancer: A Randomized Clinical Trial. European Urology Focus, 7(5), 1035–1043.

Huang, J.-H., Hu, Y.-Y., Liu, M., Wang, G.-C., Peng, B., & Yao, X.-D. (2016). Comparative study of 2 um laser versus Holmium laser for the resection of non-muscle invasive bladder cancer. In Int J Clin Exp Med (Vol. 9, Issue 12).

Kaseb, H. A. N. R. (2022, October 22). Bladder Cancer. NCBI.

Kawada, T., Ebihara, K., Suzuki, T., Imai, K., & Yamanaka, H. (1997). A New Technique for Transurethral Resection of Bladder Tumors: Rotational Tumor Resection Using a New Arched Electrode. Journal of Urology, 157(6), 2225–2226.

Kim, L. H. C., & Patel, M. I. (2020a). Transurethral resection of bladder tumour (TURBT). Translational Andrology and Urology, 9(6), 3056–3072.

Kim, L. H. C., & Patel, M. I. (2020b). Transurethral resection of bladder tumour (TURBT). Translational Andrology and Urology, 9(6), 3056–3072.

Kramer, M. W., Altieri, V., Hurle, R., Lusuardi, L., Merseburger, A. S., Rassweiler, J., Struck, J. P., & Herrmann, T. R. W. (2017). Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer. European Urology Focus, 3(6), 567–576.

Kweon, T. D., & Lee, K.-Y. (2018). Spinal anesthesia is associated with lower recurrence rates after resection of non-muscle invasive bladder cancer. Translational Andrology and Urology, 7(2), 283–286.

Liu, H., Wu, J., Xue, S., Zhang, Q., Ruan, Y., Sun, X., & Xia, S. (2013). Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. Journal of International Medical Research, 41(4), 984–992.

Liu, Z., Long, G., Zhang, Y., Sun, G., Ouyang, W., Wang, S., Xu, H., Wang, Z., Guan, W., Yu, X., Hu, Z., Chen, Z., Wang, S., & Li, H. (2021). Thulium Laser Resection of Bladder Tumors vs. Conventional Transurethral Resection of Bladder Tumors for Intermediate and High Risk Non-Muscle-Invasive Bladder Cancer Followed by Intravesical BCG Immunotherapy. Frontiers in Surgery, 8.

Rayn, K., Hale, G., Grave, G.-L., & Agarwal, P. (2018). New therapies in nonmuscle invasive bladder cancer treatment. Indian Journal of Urology, 34(1), 11.

Sun, S., Wang, H., Zhang, X., & Chen, G. (2023). Transurethral Resection of Bladder Tumor: Novel Techniques in a New Era. Bladder, 10, e21200009.

Tao, W., Sun, C., Yao, Q., Fu, K., Shan, Y., Zhang, Y., Xue, B., & Yang, D. (2020). The clinical study of en bloc transurethral resection with 980nm laser for treatment of primary non-muscle invasive bladder cancer. Journal of X-Ray Science and Technology, 28(3), 563–571.

Wang, C.-W., Lee, P.-J., Wu, C.-W., & Ho, C.-H. (2023). Comparison of Pathological Outcome and Recurrence Rate between En Bloc Transurethral Resection of Bladder Tumor and Conventional Transurethral Resection: A Meta-Analysis. Cancers, 15(7), 2055.

Woldu, S. L., Bagrodia, A., & Lotan, Y. (2017). Guideline of guidelines: non?muscle?invasive bladder cancer. BJU International, 119(3), 371–380.

Xenia B?lan, G., Aurelian Geavlete, P., Adrian Georgescu, D., Victor Ene, C., Andrei Bulai, C., Alexandra P?unescu, M., Niculae, A., Peride, I., Lasc?r, I., Paul Neagu, T., & Florin Geavlete, B. (2018). Bipolar en bloc tumor resection versus standard monopolar TURBT - which is the best way to go in non-invasive bladder cancer? Rom J Morphol Embryol, 59(3), 773–780.

Xu, H., Ma, J., Chen, Z., Yang, J., Yuan, H., Wang, T., Liu, J., Yang, W., & Ye, Z. (2018). Safety and Efficacy of En Bloc Transurethral Resection With 1.9 µm Vela Laser for Treatment of Non–Muscle-invasive Bladder Cancer. Urology, 113, 246–250.

Yang, H., Lin, J., Gao, P., He, Z., Kuang, X., Li, X., Fu, H., & Du, D. (2020). Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis. Urologia Internationalis, 104(5–6), 402–409.

Yang, Y., Liu, C., Yang, X., & Wang, D. (2020). Transurethral en bloc resection with monopolar current for non-muscle invasive bladder cancer based on TNM system. Translational Cancer Research, 9(4), 2210–2219.

Zhang, D., Yao, L., Yu, S., Cheng, Y., Jiang, J., Ma, Q., & Yan, Z. (2020). Safety and efficacy of en bloc transurethral resection versus conventional transurethral resection for primary nonmuscle-invasive bladder cancer: A meta-analysis. In World Journal of Surgical Oncology (Vol. 18, Issue 1). BioMed Central Ltd.

Zhang, K. Y., Xing, J. C., Li, W., Wu, Z., Chen, B., & Bai, D. Y. (2017). A novel transurethral resection technique for superficial bladder tumor: Retrograde en bloc resection. World Journal of Surgical Oncology, 15(1).

Zhang, X. R., Feng, C., Zhu, W. D., Si, J. M., Gu, B. J., Guo, H., Song, L. J., & Li, C. (2015). Two micrometer continuous-wave thulium laser treating primary non-muscle-invasive bladder cancer: Is it feasible? A randomized prospective study. Photomedicine and Laser Surgery, 33(10), 517–523.

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