Effect of obturator nerve block duri̇ng transurethral resecti̇on of bladder tumors on the di̇sease recurrence, progression and success of surgery

Objective: In our study, patients with primary bladder lateral wall tumors and TUR planned patients were evaluated.The effects of obturator nerve block (ONB) applied in addition to spinal anesthesia on duration of operation, hospitalization time, complete resection, presence of muscle tissue in pathology, second resection, recurrence and progression were investigated. Materials and Methods: Patients between the ages of 18-90 who applied to our clinic and whose lateralbladder wall tumor was detected in imaging methods were included in the study after informing them and obtaining their consent. Spinal anesthesia was administered to a total of 70 patients preoperatively. Patients were randomly randomized, and 35 patients received ONB in addition to spinal anesthesia. Age, gender, tumor size, operation time, hospitalization time, EORTC recurrence and progression scores, T stage, tumor grade, EAU risk class data of both groups were analyzed. The two groups were compared in terms of obturator reflex development, bladder perforation, complete resection, presence of muscle tissue in pathology samples, need for second resection, need for second resection due to lack of muscle tissue, 1-year recurrence and progression rates. Results: Demographic and disease-related data of the two groups were compared. There was no statistically significant difference between the groups in terms of age, gender, tumor size, EORTC recurrence and progression scores, risk class, T stage, tumor grade and BCG treatment. Obturator reflex development was observed at a significantly lower rate in the ONB group (p=0,002). Although bladder perforation was numerically lower in the group ONB, no statistically significant difference was observed (p=0,198). Complete resection rates were found to be 94.3% in the ONB group and 74.3% in the non-ONB group, and were statistically significantly higher in the ONB group (p=0,045). The presence of muscle tissue in pathology samples was 91.4% in the ONB group and 68.6% in the non-ONB group, which was higher in the ONB group and was statistically significant (p=0,034). Second resection rates were found to be significantly higher in the group without ONB (p=0,015). Although the number of patients who second resection due to muscle tissue deficiency was higher in the group without ONB, no statistically significant difference was found (0,106). In the 1-year follow-up, 22.9% recurrence was detected in the ONB group. This rate was found to be 68.6% in the group without ONB. The 1-year recurrence rate was significantly lower in the ONB group (p<0,001). The 1-year progression rates were compared and no significant difference was found between the groups (p=0,106). Conclusion: In our study, it was observed that ONB applied in addition to spinal anesthesia reduced the obturator reflex. We concluded that it increases the rate of complete and muscle resection, and significantly reduces the need for second resection and tumor recurrence. Keywords: Bladder cancer, obturator nerve block, tumor recurrence