The Obturator Nerve Reflex after Thulium Laser vs. Monopolar Transurethral Resection of Bladder Tumors: A Randomized Clinical trial
5 January 2019
Background: Obturator nerve reflex is the surgery treatment side effect in patients with bladder cancers. This study is run to determine the obturator Nerve reflex by Thulium laser versus monopolar Transurethral Resection of Bladder Tumors (TURBT).
Materials and methods: After clinical trial approval code receiving IRCT20190624043991N4, one hundred and eighty-nine patients with bladder tumors from 2010 to 2016 were assessed and among them, 35 patients were randomly assigned into two groups in a blinded manner; the first group (16 patients) received thulium laser and the second group (19 patients) were patients undergoing monopolar transurethral resection of bladder tumor after spinal analgesia. Clinical data, including different variables such as; age, tumor characteristics, gender, operation duration, types of leg jerking, and some intraoperative complications, were recorded. The site of the obturator nerve was determined by nerve stimulation, anatomical landmarks, and ultrasonography. Leg jerking was compared in both groups.
Results: Of the 35 patients, 28 cases were male and 7 cases were female. The mean age was 62.0±6.9 (40-75) years in the Thulium laser group and 64.0±7.1 (41-77) years in the monopolar TURBT group. The mean operation time was no different between the two groups significantly (P > 0.05). Leg jerking was reported in 25% and 63.1% of the patients in Thulium laser and monopolar TURBT groups, respectively (P<0.05).
Conclusion: Thulium laser is a more feasible and effective method to prevent leg jerking in patients with bladder cancer; so, it is recommended more than monopolar Transurethral.
- Monopolar TURBT, Thulium Laser, Non-muscle-invasive bladder tumor, Leg jerking
Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. 2017;71:96-108.
Ibrahim SM, Mohamed E, Elsharawy I, Kamal K. Transurethral resection of bladder tumor (TUR-BT) then concomitant radiation and cisplatin followed by adjuvant gemcitabine and cisplatin in muscle invasive transitional cell carcinoma (TCC) of the urinary bladder. J Egypt Natl Canc Inst. 2007;19:77-86.
Golan S, Baniel J, Lask D, Livne PM, Yossepowitch O. Transurethral resection of bladder tumour complicated by perforation requiring open surgical repair–clinical characteristics and oncological outcomes. BJU international. 2011;107:1065-8.
Augspurger RR, Donohue RE. Prevention of obturator nerve stimulation during transurethral surgery. The Jou of Urol. 1980;123:170-2.
Jo SY, Chang JC, Bae HG, Oh J-S, Heo J, Hwang JC. A morphometric study of the obturator nerve around the obturator foramen. Journal of Korean Neurosurgical Society. 2016;59:282.
Locher S, Burmeister H, Böhlen T, Eichenberger U, Stoupis C, Moriggl B, et al. Radiological anatomy of the obturator nerve and its articular branches: basis to develop a method of radiofrequency denervation for hip joint pain. Pain medicine. 2007;9:291-8.
Liu H, Wu J, Xue S, Zhang Q, Ruan Y, Sun X, et al. 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. 2013;41:984-92.
Kramer MW, Bach T, Wolters M, Imkamp F, Gross AJ, Kuczyk MA, et al. Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer. World journal of urology. 2011;29:433-42.
Soler-Martínez J, Vozmediano-Chicharro R, Morales-Jiménez P, Hernández-Alcaraz D, Vivas-Vargas E, García-Vaquero IS, et al. Holmium laser treatment for low grade, low stage, noninvasive bladder cancer with local anesthesia and early instillation of mitomycin C. The Jou of Urol. 2007;178:2337-9.
Bach T, Xia S, Yang Y, Mattioli S, Watson G, Gross A, et al. Thulium: YAG 2 μm cw laser prostatectomy: where do we stand? World journal of urology. 2010;28:163-8.
Bolat D, Aydogdu O, Tekgul ZT, Polat S, Yonguc T, Bozkurt IH, et al. Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study. Canadian Urological Association Journal. 2015;9:E780.
Shah NF, Sofi KP, Nengroo SH. Obturator nerve block in transurethral resection of bladder tumor: a comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique. Anesthesia, essays and researches. 2017;11:411.
Kati B, Izgi M. A nightmare during endoscopic bladder tumor resection: obturator reflex. J Turgut Ozal Med Cent. 2017;24:371-4.
Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Roedel CM, et al. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol. 2014;66:120-37.
Smith ZL, Christodouleas JP, Keefe SM, Malkowicz SB, Guzzo TJ. Bladder preservation in the treatment of muscle‐invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy. BJU international. 2013;112:13-25.
Russell CM, Lebastchi AH, Borza T, Spratt DE, Morgan TM. The role of transurethral resection in trimodal therapy for muscle-invasive bladder cancer. Bladder Cancer. 2016;2:381-94.
Migliari R, Buffardi A, Ghabin H. Thulium laser endoscopic en bloc enucleation of nonmuscle-invasive bladder cancer. Journal of endourology. 2015;29:1258-62.
Xu H, Ma J, Chen Z, Yang J, Yuan H, Wang T, et al. Safety and Efficacy of En Bloc Transurethral Resection With 1.9 µm Vela Laser for Treatment of Non–Muscle-invasive Bladder Cancer. Urology. 2018;113:246-50.
Teng J-f, Kai W, Lei Y, Qu F-j, Zhang D-x, Cui X-g, et al. Holmium laser versus conventional transurethral resection of the bladder tumor. LWW; 2013.
Bai Y, Liu L, Yuan H, Li J, Tang Y, Pu C, et al. Safety and efficacy of transurethral laser therapy for bladder cancer: a systematic review and meta-analysis. World journal of surgical oncology. 2014;12:301.
Ozer K, Horsanali MO, Gorgel SN, Ozbek E. Bladder injury secondary to obturator reflex is more common with plasmakinetic transurethral resection than monopolar transurethral resection of bladder cancer. Central European journal of urology. 2015;68:284.
Balci M, Tuncel A, Keten T, Guzel O, Lokman U, Koseoglu E, et al. Comparison of monopolar and bipolar transurethral resection of non-muscle invasive bladder cancer. Urologia internationalis. 2018;100:100-4.
Venkatramani V, Panda A, Manojkumar R, Kekre NS. Monopolar versus bipolar transurethral resection of bladder tumors: a single center, parallel arm, randomized, controlled trial. The Jou of Urol. 2014;191:1703-7.
Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, et al. Current evidence of transurethral Ho: YAG and Tm: YAG treatment of bladder cancer: update 2014. World journal of urology. 2015;33:571-9.
- Abstract Viewed: 0 times
- Just Accepted/5599 Downloaded: 0 times