Department of Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Department of Anesthesiology and Reanimation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Int Urol Nephrol. 2023 Nov;55(11):2765-2772. doi: 10.1007/s11255-023-03727-6. Epub 2023 Aug 2.
In our study, we aimed to evaluate the effect of the obturator nerve block (ONB) on the operation time, duration of hospital stay, complete resection, presence of muscle tissue in the pathology, second resection, recurrence, and progression, when applied in addition to spinal anesthesia in patients with primary bladder lateral wall tumor and Transurethral Resection of Bladder Tumor (TURBT) was planned.
Seventy patients with bladder lateral wall tumors were included in the study. In addition, ONB was applied to 35 of the patients who underwent spinal anesthesia. The two groups were compared in terms of obturator reflex development, perforation, complete resection, presence of muscle tissue in pathology samples, need for second resection, need for second resection due to inadequate muscle tissue, and 1 year recurrence and progression rates.
When the two groups were compared for obturator reflex and bladder perforation, both were found to be lower in the ONB group (p = 0.002, p = 0.198, respectively). The rate of complete resection and the presence of muscle tissue in the pathology samples were higher in the ONB group (p = 0.045, p = 0.034, respectively). The rates of second resection and second resection due to inadequate muscle tissue were found to be higher in the group without ONB (p = 0.015, p = 0.106, respectively). In the 1-year follow-up, the recurrence rate was significantly lower in the ONB group (p < 0.001), while there was no significant difference between the progression rates (p = 0.106).
In our study, we found out that ONB applied in addition to spinal anesthesia increases the rate of complete and muscle tissue resection by decreasing the obturator reflex, and causes a significant reduction in the need for second resection and tumor recurrence.
在我们的研究中，我们旨在评估闭孔神经阻滞（ONB）在计划行脊髓麻醉和经尿道膀胱肿瘤切除术（TURBT）的原发性膀胱侧壁肿瘤患者中的作用，即在手术时间、住院时间、完全切除、病理中存在肌肉组织、二次切除、复发和进展方面的影响。
将 70 例膀胱侧壁肿瘤患者纳入研究。其中 35 例患者在脊髓麻醉的基础上加用 ONB。比较两组患者的闭孔反射发生情况、穿孔、完全切除、病理标本中存在肌肉组织、需要二次切除、因肌肉组织不足而需要二次切除以及 1 年复发和进展率。
比较两组患者的闭孔反射和膀胱穿孔情况，ONB 组的发生率均较低（p=0.002，p=0.198）。ONB 组的完全切除率和病理标本中存在肌肉组织的比例较高（p=0.045，p=0.034）。无 ONB 组的二次切除率和因肌肉组织不足而需要二次切除的比例较高（p=0.015，p=0.106）。在 1 年随访中，ONB 组的复发率显著降低（p<0.001），而进展率无显著差异（p=0.106）。
在我们的研究中，我们发现，与脊髓麻醉联合应用的 ONB 通过降低闭孔反射来增加完全切除和存在肌肉组织的比例，并显著降低二次切除和肿瘤复发的需求。
