Department of Urology, Medical College and Hospital, Kolkata, West Bengal, India.
Department of Anesthesia, Medical College and Hospital, Kolkata, West Bengal, India.
Urologia. 2024 Nov;91(4):695-700. doi: 10.1177/03915603241266907. Epub 2024 Jul 26.
Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve.
In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken.
In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively.
Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate.
膀胱肿瘤是最常见的泌尿系统恶性肿瘤之一。传统上，它通过经尿道膀胱肿瘤切除术（TURBT）进行诊断和治疗。在进行侧壁肿瘤的 TURBT 时，存在闭孔神经反射（ONR）的风险，这可能导致严重的并发症，如意外出血和膀胱穿孔。为了防止这种情况，在脊髓麻醉后给予闭孔神经阻滞。在这项研究中，我们使用经膀胱入路来阻滞闭孔神经。
共有 60 名患者纳入本研究。其中 30 例仅在脊髓麻醉下和经膀胱闭孔神经阻滞（ONB）下行 TURBT。在另外 30 例患者中，在脊髓麻醉下和外周神经刺激器（PNS）引导下进行闭孔神经阻滞（由麻醉师进行），并进行 TURBT。所有患者均采用常规单极电切术进行 TURBT。研究了手术时间和围手术期并发症。所有患者均签署了知情同意书。
在本研究中，经膀胱进行了 30 次 ONB（均为双侧）。在确认闭孔神经位置后，使用局部麻醉剂进行经膀胱 ONB。2 名患者（6.67%）在手术中出现内收肌反射。在接受外周神经刺激器（PNS）引导的 30 例患者中，有 6 例（20%）在手术中出现内收肌反射，其中 1 例（3.33%）出现膀胱穿孔，保守治疗。
经膀胱 ONB 是预防侧壁肿瘤 TURBT 中内收肌反射的一种简便方法。学习曲线较短，成功率较高。
