Comparison of Oncologic and Functional Outcomes of Orifice Resection via Monopolar and Bipolar System in Bladder Tumors with Orifice Involvement

INTRODUCTION: While monopolar and bipolar energy modalities are commonly used, their comparative impact on oncologic and functional outcomes remains uncertain regarding transurethral resection (TUR) of bladder tumors involving the ureteral orifice. METHODS: A total of 112 patients undergoing TUR for orifice-involved bladder tumors were retrospectively analyzed, with 46 treated with monopolar (group 1) and 66 with bipolar energy (group 2). Primary outcomes included upper tract urothelial carcinoma (UTUC) development and functional complications such as new-onset hydronephrosis (HN). RESULTS: The mean tumor size was significantly larger in group 2 (67.8 mm vs. 45 mm, p = 0.014). UTUC developed in 5 patients in group 1 and 1 patient in group 2 (p = 0.066). Although the mean UTUC-free survival time was longer in group 1 than in group 2 (39.4 ± 23.3 months vs. 5 months), there was no significant difference between the groups (p = 0.578). Postoperative HN occurred in 11 patients in group 1 and 17 patients in group 2 (p = 0.603), and the bipolar group exhibited more spontaneous resolution. CONCLUSION: Fewer HN and a trend toward lower UTUC incidence suggest a potential advantage of bipolar systems in preserving ureteral integrity. Prospective randomized trials are warranted to validate these findings and establish evidence-based strategies.