Efficacy of Obturator Nerve Block During Transurethral Resection on Non-muscle invasive Intermediate and High Risk Lateral Wall Bladder Tumours: A Prospective Randomized Controlled Study
Vol. 19 No. 06 (2022),
Purpose: We aimed to investigate the effects of obturator nerve block (ONB) on obturator reflex, incomplete resection, perforation, progression and recurrence of tumor, presence of muscle tissue in the specimen, need for a second transurethral resection (TURBT) of bladder tumors, and postoperative complications in patients who underwent TURBT for intermediate-high risk lateral wall non-muscle invasive bladder cancers (NMIBC).
Material and Methods: Patients were assigned to one of two groups by drawing lots: ONB or none ONB. Early and late recurrence, tumor progression, obturator reflex beat, incomplete resection, perforation, presence of muscle layer in pathology, second TURBT application, operation time, postoperative hospital stay, and complications were compared between the two groups.
Results: The median follow-up time of the study was32 (23-41) months. Interquartile range (IQR) was 9. Tumor recurrence at the 3rd month cystoscopy controls was observed in 5 (9.8%) patients in the ONB group, while it was observed in 11 (20.8%) patients in the nONB group (p=0.01). Late tumor recurrence was observed in 10 patients (19.6%) in the ONB group, and in 20 patients (37.7%) in the nONB group (p=0.041). The RFS rate at 12th month was 84% in the ONB group, 69% in the nONB group, 79% in the ONB group at 36th month, and 58% in the nONB group at 36 months, the PFS rate was 94% in the ONB group, while it was 85% in the nONB group (p=0.041).
Conclusion: Our study showed that ONB decrease the early and late recurrence and increase recurrence free survival in patients with intermediate-high risk lateral wall bladder cancer.
- Bladder Cancer; Obturator nerve block; Progression free survival; recurrence free survival
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2. Tekgül ZT, Divrik RT, Turan M et al. Impact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall. Urol J 2014;11(1):1248-1252.
3. Panagoda PI, Vasdev N, Gowrie-Mohan S. Avoiding the Obturator Jerk during TURBT. Curr Urol 2018;12(1):1-5. doi: 10.1159/000447223
4. Deliveliotis C, Alexopoulou K, Picramenos D et al. The contribution of the obturator nerve block in the transurethral resection of bladder tumors. Acta Urol Belg 1995;63(3):51-54.
5. Bolat D, Aydogdu O, Tekgul ZT 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. Can Urol Assoc J 2015;9:E780-784. doi: 10.5489/cuaj.3149
6. Erbay G, Akyol F, Karabakan M et al. 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. Kaohsiung J Med Sci 2017;33(2):86-90. doi: 10.1016/j.kjms.2016.11.006.
7. Babjuk M, Burger M, Compérat EM et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) - 2019 Update. Eur Urol 2019;76(5):639-657. doi: 10.1016/j.eururo.2019.08.016
8. Akata T, Murakami J, Yoshinaga A. Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand 1999;43:784-788. doi: 10.1034/j.1399-6576.1999.430717.x
9. Augspurger RR, Donohue RE. Prevention of obturator nerve stimulation during transurethral surgery. J Urol 1980;123:170-172. doi: 10.1016/s0022-5347(17)55837-1
10. Kobayashi M, Takeyoshi S, Takiyama R et al. [A report on 107 cases of obturator nerve block]. Masui 1991;40:1138-1143. Japanese.
11. Gasparich JP, Mason JT, Berger RE. Use of nerve stimulator for simple and accurate obturator nerve block before transurethral resection. J Urol 1984;132:291-293. doi: 10.1016/s0022-5347(17)49600-5
12. Lee SH, Jeong CW, Lee HJ et al. Ultrasound guided obturator nerve block: a single interfascial injection technique. J Anesth 2011;25:923-926. doi: 10.1007/s00540-011-1228-y
13. Bourjila G,Noh E. Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors: a comparison of monopolar and bipolar TUR-BT regarding the presence of detrusor muscle in tumor specimens and recurrence of disease. Journal of Medicine in Scientific Research 2020;3:44-48.
14. Khorrami MH, Javid A, Saryazdi H et al. Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral bladder surgery. J Endourol 2010;24:1651-1654. doi: 10.1089/end.2009.0659
15. Jancke G, Rosell J, Jahnson S. Residual tumour in the marginal resection after a complete transurethral resection is associated with local recurrence in Ta/T1 urinary bladder cancer. Scand J Urol Nephrol 2012;46(5):343-347. doi: 10.3109/00365599.2012.684700
16. Akand M, Muilwijk T, Raskin Y et al. Quality Control Indicators for Transurethral Resection of Non-Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer. 2019 Aug;17(4):e784-e792. doi: 10.1016/j.clgc.2019.04.014
17. Kurth KH, Bouffioux C, Sylvester R et al. Treatment of superficial bladder tumors: achievements and needs. The EORTC Genitourinary Group. Eur Urol 2000;37 Suppl 3:1-9. doi: 10.1159/000052386
18. Dalbagni G, Herr HW, Reuter VE. Impact of a second transurethral resection on the staging of T1 bladder cancer. Urology 2002;60:822-824; discussion 824-5. doi: 10.1016/s0090-4295(02)01920-9
19. Cheng L, Neumann RM, Weaver AL et al. Grading and staging of bladder carcinoma in transurethral resection specimens. Correlation with 105 matched cystectomy specimens. Am J Clin Pathol 2000;113:275-279. doi: 10.1309/94B6-8VFB-MN9J-1NF5
20. Wijkström H, Norming U, Lagerkvist M et al. Evaluation of clinical staging before cystectomy in transitional cell bladder carcinoma: a long-term follow-up of 276 consecutive patients. Br J Urol 1998;81:686-691. doi: 10.1046/j.1464-410x.1998.00637.x
21. Angulo JC, Palou J, García-Tello A et al. Second transurethral resection and prognosis of high-grade non-muscle invasive bladder cancer in patients not receiving bacillus Calmette-Guérin. Actas Urol Esp 2014;38:164-171. English, Spanish. doi: 10.1016/j.acuro.2014.01.001
22. Gontero P, Sylvester R, Pisano F et al. The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guérin. BJU Int 2016;118:44-52. doi: 10.1111/bju.13354
23. Svatek RS, Hollenbeck BK, Holmäng S et al. The economics of bladder cancer: costs and considerations of caring for this disease. Eur Urol 2014;66:253-262. doi: 10.1016/j.eururo.2014.01.006
24. Sylvester RJ, van der Meijden AP, Oosterlinck W et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006;49:466-5; discussion 475-7. doi: 10.1016/j.eururo.2005.12.031
25. Tatlisen A, Sofikerim M. Obturator nerve block and transurethral surgery for bladder cancer. Minerva Urol Nefrol 2007;59:137-141.
26. Comploj E, Dechet CB, Mian M et al. Perforation during TUR of bladder tumours influences the natural history of superficial bladder cancer. World J Urol 2014;32:1219-1223. doi: 10.1007/s00345-013-1197-x
27. Giraldi G, Montesano M, Sandorfi F et al. Excess length of hospital stay due to healthcare acquired infections: methodologies evaluation. Ann Ig 2019;31:507-516. doi: 10.7416/ai.2019.2311
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