Skip to main content

Advertisement

Log in

Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique—a prospective randomised study

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To establish whether bipolar transurethral resection of tumours (bTURB) on the lateral bladder wall is superior to monopolar transurethral resection (mTURB) of such tumours. To our knowledge, this is the first prospective randomised study, which defines complete resection depending on obturator jerk as primary endpoint.

Methods

In a prospective, randomised, single centre study, 52 patients with newly diagnosed or recurrent bladder tumour on the lateral bladder wall were enrolled and randomised to undergo mTURB or bTURB; 44 patients were eligible for analysis, of whom 21 underwent mTURB and 23 bTURB. Any differences between the two techniques related to the incidence of unwanted stimulation of the obturator nerve and subsequent adductor spasms were evaluated. All procedures were carried out under laryngeal mask anaesthesia without obturator nerve block (ONB) and without drug-induced relaxation.

Results

Baseline characteristics of the two study groups did not differ statistically significantly. The success rate defined as complete resection of the bladder tumour without any clinically relevant adductor spasm was 61.9% in the monopolar group and 82.6% in the bipolar group (p = 0.18).

Conclusions

Complete, undisturbed resection of tumours of the lateral bladder wall is feasible with mTURB and bTURB. Adductor spasms due to obturator jerk can occur suddenly with the risk of bladder perforation. We therefore support ONB when using spinal anaesthesia and drug-induced relaxation when using general anaesthesia when performing TURB on the lateral bladder wall.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CTU:

Clinical trials unit

NMIBC:

Non-muscle-invasive bladder cancer

ON:

Obturator nerve

ONB:

Obturator nerve block

TURB:

Transurethral resection of bladder tumour

bTURB:

Bipolar transurethral resection of bladder tumour

mTURB:

Monopolar transurethral resection of bladder tumour

References

  1. American Cancer Society (2017) Cancer facts & figures 2017. American Cancer Society, Atlanta

    Google Scholar 

  2. Ploeg M, Aben KH, Kiemeney LA (2009) The present and future burden of urinary bladder cancer in the world. World J Urol 27(3):289–293

    Article  PubMed  PubMed Central  Google Scholar 

  3. Burger M, Catto JWF, Dalbagni G et al (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63(2):234–241

    Article  PubMed  Google Scholar 

  4. Rübben H (2007) Uroonkologie. Springer, Berlin

    Book  Google Scholar 

  5. Meyer D, Schmid H-P, Engeler DS (2007) Therapie und Nachsorge bei malignen Blasentumoren. Wien Med Wochenschrift 157(7–8):162–169

    Article  Google Scholar 

  6. Song X, Yang D, Che X et al (2010) Comparing the safety and efficiency of conventional monopolar, plasmakinetic, and holmium laser transurethral resection of primary non-muscle invasive bladder cancer. J Endourol 24(1):69–73

    Article  Google Scholar 

  7. Creevy CD (1969) Preventing stimulation of the obturator nerve during transurethral resection. J Urol 101:368

    Article  PubMed  CAS  Google Scholar 

  8. Augspurger RR, Donohue RE (1980) Prevention of obturator nerve stimulation during transurethral surgery. J Urol 123(2):170–172

    Article  PubMed  CAS  Google Scholar 

  9. Brunken C, Qiu H, Tauber R (2004) Transurethrale Resektion von Blasentumoren in Kochsalzlösung. Urologe A 43(9):1101–1105

    Article  PubMed  CAS  Google Scholar 

  10. Tatlisen A, Sofikerim M (2007) Obturator nerve block and transurethral surgery for bladder cancer. Minerva Urol e Nefrol 59(2):137–141

    CAS  Google Scholar 

  11. Pladzyk K, Jureczko L, Łazowski T (2012) Over 500 obturator nerve blocks in the lithotomy position during transurethral resection of bladder tumor. Cent Eur J Urol 65(2):67–70

    Article  Google Scholar 

  12. Bolat D, Aydogdu O, Tekgul ZT et al (2015) 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 9(11–12):780

    Article  Google Scholar 

  13. Khorrami MH, Javid A, Saryazdi H et al (2010) Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral bladder surgery. J Endourol 24(10):1651–1654

    Article  PubMed  Google Scholar 

  14. Puppo P, Bertolotto F, Introini C et al (2009) Bipolar transurethral resection in saline (TURis): outcome and complication rates after the first 1000 cases. J Endourol 23(7):1145–1149

    Article  PubMed  Google Scholar 

  15. Rose A, Suttor S, Goebell PJ et al (2017) Transurethral resection of bladder tumors and prostate enlargement in physiological saline solution (TURIS). A prospective study. Urologe A 46(9):1148–1150

    Article  Google Scholar 

  16. Picozzi S, Marenghi C, Ricci C et al (2014) Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease. Surg Endosc 28(1):116–121

    Article  PubMed  Google Scholar 

  17. Babjuk M, Böhle A, Burger M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71(3):447–461

    Article  PubMed  Google Scholar 

  18. Zhao C, Tang K, Yang H et al (2016) Bipolar versus monopolar transurethral resection of nonmuscle-invasive bladder cancer: a meta-analysis. J Endourol 30(1):5–12

    Article  PubMed  Google Scholar 

  19. Cui Y, Chen H, Liu L et al (2016) Comparing the efficiency and safety of bipolar and monopolar transurethral resection for non-muscle invasive bladder tumors: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech 26(3):196–202

    Article  Google Scholar 

  20. Geavlete B, Multescu R, Georgescu D et al (2012) Narrow band imaging cystoscopy and bipolar plasma vaporization for large nonmuscle-invasive bladder tumors—results of a prospective, randomized comparison to the standard approach. Urology 79(4):846–851

    Article  PubMed  Google Scholar 

  21. Venkatramani V, Panda A, Manojkumar R, Kekre NS (2014) Monopolar versus bipolar transurethral resection of bladder tumors: a single center, parallel arm, randomized, controlled trial. J Urol 191(6):1703–1707

    Article  PubMed  Google Scholar 

  22. Del Rosso A, Pace G, Masciovecchio S et al (2013) Plasmakinetic bipolar versus monopolar transurethral resection of non-muscle invasive bladder cancer: a single center randomized controlled trial. Int J Urol 20(4):399–403

    Article  PubMed  CAS  Google Scholar 

  23. Mashni J, Godoy G, Haarer C et al (2014) Prospective evaluation of plasma kinetic bipolar resection of bladder cancer: comparison to monopolar resection and pathologic findings. Int Urol Nephrol 46(9):1699–1705

    Article  PubMed  PubMed Central  Google Scholar 

  24. Balci M, Tuncel A, Keten T et al (2018) Comparison of monopolar and bipolar transurethral resection of non-muscle invasive bladder cancer. Urol Int 100(1):100–104

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

TG: protocol development, data collection, data analysis, manuscript writing; CS, VZ, PB, HPS: data collection; MM: protocol development, data collection; DSE: project development, protocol development, data collection, data analysis, manuscript editing.

Corresponding author

Correspondence to T. Gramann.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gramann, T., Schwab, C., Zumstein, V. et al. Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique—a prospective randomised study. World J Urol 36, 1085–1091 (2018). https://doi.org/10.1007/s00345-018-2248-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2248-0

Keywords

Navigation