Introduction: Bladder cancer is the seventh most common cancer in the UK. Transurethral resection of bladder tumor (TURBT) is a relatively common procedure used to treat cancer of the bladder. A serious complication of TURBT is bladder perforation, the risk of which is greatly increased in the presence of an “obturator jerk”. Methods: A literature search was performed on PubMed using the following search criteria “obturator nerve block”, “obturator nerve block in transurethral resection of bladder tumor”, “adductor spasm during transurethral resection of bladder tumor”, “bi-polar diathermy obturator nerve”, and “transvesical obturator nerve block”. Articles describing surgical and anesthetic techniques for reducing adductor spasm during resection of bladder tumors were included. Discussion: TURBT is a relatively common urological operation performed to remove tumors of the bladder. Every measure should be taken to avoid serious complications from both anesthesia and surgery. Surgical measures to reduce the likelihood of an obturator jerk include reducing the diathermy current, avoiding over-distention bladder, and using bipolar diathermy as opposed to monopolar diathermy (although there is conficting evidence for this in the literature). Anesthetists should consider the use of neuromuscular blockade or an obturator nerve block to reduce the incidence of obturator jerk and risk of bladder perforation.

Penile erection at the time of urological surgery is a rare but problematic event which can delay, complicate or even lead to the cancellation of planned surgery. Erection may occur irrespective of the type of anesthetic method employed. Several techniques for treatment of this troublesome complication have been described in the literature, all with varying levels of success and potential adverse effects. In our experience over the last 25 years, we have found that intracavernous injection of ephedrine into the penis has a 100% success rate in safely producing detumescence with minimum side effects and should therefore be considered early among the treatment options for this condition.

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Objectives: To investigate what clinical features typically present in transurethral resection (TUR) syndrome and to see which classically present first. The purpose of the study was to establish whether or not a particular method of anesthesia is preferred in detecting this syndrome in its early stages. Methods: A total of 1,502 transurethral resection of the prostate (TURP) over a 15 year period were reviewed to see which, if any, went on to experience this complication. Of these cases, 48 developed TUR syndrome. The case records were reviewed retrospectively and the presenting clinical features were analysed. All TURPs were routinely performed under spinal anesthesia and followed a standardised set up. The irrigation fluid used in all operations was Glycine 1.5%. Results: Forty eight patients displayed clinical features of TUR syndrome giving an incidence of 3.2%. Trainees of varying experience caused all but one case. Median resection time, resection weight and volume of intraoperative glycine irrigation fluid were 55 minutes (range 40-75 minutes), 44 grams (range 24-65 g), and 28 l (24-48 l) respectively. Only 16/48 TURPs had a recorded capsular perforation. Pre- vs. post-operative median hematocrit, hemoglobin and serum sodium were 0.42 vs. 0.33, 14.2 g/dl vs. 10.1 g/dl and 142 mmol/l vs. 121 mmol/l respectively. Patients presented with nausea 44/48, vomiting 28/48, visual disturbance 29/48, apprehension 37/48, disorientation 17/48, breathing difficulties 17/48, and bradycardia 19/21. The earliest observed sign was nausea 21/48, then bradycardia 11/48, apprehension 11/48, and visual disturbance 10/48; after which the procedure was abandoned. None of the patients developed stupor, coma or seizures. Out of the 48 patients, 9 were admitted to high dependency units and all of these were treated with IV furosemide. One patient required a blood transfusion. All patients recovered within 48 hours (range 18-48 hours) and none had any long term complications on follow up. Conclusion: The features most associated with the early presentation of TUR syndrome require the patient to be conscious for detection. The use of spinal anaesthesia is therefore desirable to facilitate its early recognition.

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