Doluoglu Omer Gokhan, Yildiz Ali Kaan, Kacan Turgay, Bayburtluoglu Veysel, Bektas Meltem, Ozgur Berat Cem
University of Medical Sciences, Department of Urology Clinic of Ankara Training and Research Hospital, Ankara, Turkey.
University of Medical Sciences, Department of Anesthesiology, Clinic of Ankara Training and Research Hospital, Ankara, Turkey.
Urol J. 2022 Dec 6;19(6):445-450. doi: 10.22037/uj.v18i.6953.
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).
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.
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).
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.
我们旨在研究闭孔神经阻滞（ONB）对接受经尿道膀胱肿瘤电切术（TURBT）治疗的中高危侧壁非肌层浸润性膀胱癌（NMIBC）患者的闭孔反射、肿瘤不完全切除、穿孔、进展和复发、标本中肌肉组织的存在、二次经尿道膀胱肿瘤电切术（TURBT）的必要性以及术后并发症的影响。
通过抽签将患者分为两组：ONB组和非ONB组。比较两组之间的早期和晚期复发、肿瘤进展、闭孔反射搏动、不完全切除、穿孔、病理中肌肉层的存在、二次TURBT的应用、手术时间、术后住院时间和并发症。
该研究的中位随访时间为32（23 - 41）个月。四分位间距（IQR）为9。在ONB组中，5例（9.8%）患者在第3个月膀胱镜检查时观察到肿瘤复发，而在非ONB组中，11例（20.8%）患者观察到肿瘤复发（p = 0.01）。ONB组中有10例患者（19.6%）观察到晚期肿瘤复发，非ONB组中有20例患者（37.7%）观察到晚期肿瘤复发（p = 0.041）。ONB组在第12个月时无复发生存率为84%，非ONB组为69%；ONB组在第36个月时为79%，非ONB组为58%，无进展生存率在ONB组为94%，非ONB组为85%（p = 0.041）。
我们的研究表明ONB可降低中高危侧壁膀胱癌患者的早期和晚期复发率，并提高无复发生存率。
