Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease

Abstract

We investigated the effect of spinal anesthesia combined with obturator nerve block (ONB) during the transurethral resection of lateral bladder wall tumors (TUR-BT) on the presence of detrusor muscle tissue in tumor specimens and on tumor recurrence. TUR-BT was performed on 96 patients with a lateral bladder wall tumor under spinal anesthesia in our clinic between January 2011 and December 2015. The patients were divided into two groups: 49 patients only received spinal anesthesia and 47 patients received spinal anesthesia combined with ONB. The groups were retrospectively compared in terms of adductor muscle contraction, bladder perforation, complete tumor resection, presence of muscle tissue in the pathology material, and recurrence rate during follow-up. The obturator reflex was significantly observed in the non-ONB group (p < 0.05). In the ONB group, the percentages of complete resection and detrusor muscle tissue were significantly higher (p = 0.003 and p = 0.001, respectively). The postoperative recurrence rate was found to be significantly higher in the non-ONB group than in the ONB group (p = 0.025). Spinal anesthesia combined with ONB during TUR-BT prevent obturator reflex and facilitate complete resection including detrusor muscle tissue, independent from the size or number of tumors, thus reducing the recurrence of the disease.

Monopolar versus bipolar transurethral resection of lateral wall-located bladder cancer under obturator nerve block: a single center prospective randomized study

“…Most urologists are concerned about some possible complications that may occur during resection of lateral wall-located bladder tumors when obturator nerve is close to lateral wall in its intrapelvic course (19). Depending on the resectoscope type, anesthesia technique, and ONB procedure, the previous studies reported that obturator jerk was detected in 2.1-82.6% of the patients during the TUR of lateral and inferolateral bladder tumors (18,20,21). Furthermore, at least half of the bladder tumors are located on the lateral wall (13).…”

“…Furthermore, Erbay et al reported that spinal anesthesia, combined with ONB, during TURBT prevents obturator reflex and facilitates complete resection including detrusor muscle tissue, independent from the size and number of tumors, and thus reduces the recurrence of the disease (20). Despite the ONB, obturator jerk was still observed in some cases.…”

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

“…The complication rate increases during TURB due to the development of inappropriate surgical conditions not associated with the adductor muscle contraction, which results in inadequate resection and inadequate treatment [17]. The ONB, which is performed for prevention of adductor muscle contraction, is an effective method for enabling an appropriate environment for surgery [18]. The ONB has been shown to be a basic skill for urologists in addition to the other methods during TURBT [19].…”

Komplikationsmanagement bei der TUR-Blase

“…Ebenso können operationstechnische Veränderungen wie eine intermittierende Resektion oder eine reduzierte Stromleistung eine Reizung des Muskels während der TUR-Blase vermeiden. Neben der Risikoreduktion der Perforation konnte mit diesen Maßnahmen zudem auch die Vollständigkeit der Tumorresektion verbessert werden, das Vorliegen von Muskelgewebe in der endgültigen Histologie erhöht und hierdurch das erneute Auftreten des Blasentumors vermindert werden [43]. Eine geringere obturatorische Reizung ist ebenso durch Verwendung eines bipolaren im Vergleich zum monopolaren Resektionsverfahrens möglich [44].…”