Bladder injury secondary to obturator reflex is more common with plasmakinetic transurethral resection than monopolar transurethral resection of bladder

Ozer, Kutan; Horsanalı, Mustafa Ozan; Görgel, Sacit Nuri; Özbek, Emin

doi:10.5173/ceju.2015.565

Cited by 20 publications

(15 citation statements)

References 12 publications

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“…Also, Mansour et al [9], in a controlled randomised trial, reported a 13.2% perforation rate with monopolar resection that was significantly higher than the 2.4% for bipolar resection (P = 0.02). Conversely, Ozer et al [23], reported that bladder injury was statistically significantly higher in the bipolar group, with bladder perforation seen in 10 (23%) patients vs four (8%) (P = 0.4). Furthermore, in another study, it was reported that a significant rate of obturator jerks and subsequent perforation in their first 10 patients when the power setting of the bipolar machine was adjusted to 160 and 80 W for cutting and coagulation, respectively.…”

Section: Discussionmentioning

confidence: 88%

“…Also, Mansour et al [9] reported a significant decrease in the incidence of nerve stimulation from 26.5% with M-TURBT vs 4.8% with B-TURBT (P = 0.01). Conversely, Ozer et al [23] reported that the obturator reflux was statistically significantly higher in B-TURBT group; with the obturator reflex observed in 15 (34%) patients vs four (8%) (P = 0.001). Also, in the Venkatramani et al [18] report, the incidence of obturator jerk was greater in the B-TURBT arm (60% vs 49.2%, P = 0.27).…”

Section: Discussionmentioning

confidence: 89%

“…In our present study, the hospital time was also shorter in the B-TURBT group at 1 day vs the M-TURBT group at 2 days. Conversely, Ozer et al [23] reported that the mean (SD) hospitalisation time was statistically significantly lower in the monopolar arm at 1.58 (1.03) vs 2.09 (1.17) days in the bipolar arm (P = 0.001).…”

Section: Discussionmentioning

confidence: 92%

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Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

Mahmoud

Tawfick

Mostafa

et al. 2019

Arab Journal of Urology

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Objectives: To assess the safety and the effectiveness of bipolar energy in the transurethral resection of primary large bladder tumours (TURBT) and compare it to conventional monopolar energy. Patients and methods: From November 2015 to June 2017, 80 patients underwent endoscopic resection primarily for large bladder cancer tumours of >3 cm. They were randomly assigned into two groups: 40 patients underwent a TURBT with conventional monopolar current (M-TURBT) and 40 were treated with bipolar current (B-TURBT). Results: There were no statistically significant differences between the two groups for the patients' demographic and tumour characteristics. There was a significant difference between M-TURBT and B-TURBT for resection time, obturator reflex, hospital stay, and catheterisation time, which were all higher in the M-TURBT group; the mean (SD) resection time was 26.45 (5.73) vs 22.85 (7.52) min (P = 0.048), the obturator reflex was 25% vs 5% (P = 0.025), the median hospital stay and catheterisation times were 2 vs 1 day (P = 0.012 and P = 0.023, respectively). No statistically significant difference was found between the groups for bladder perforation, TUR syndrome, drop in haemoglobin level, and blood transfusion rate. However, there was statically significant difference in the postoperative haematuria rate, which was higher in the M-TURBT group, at 24 patients vs eight in the B-TURBT group (60% vs 20%; P = 0.01). After 1-year follow-up, there was no significant difference in the recurrence rate between the groups. Conclusion: B-TURBT is a safe and effective alternative procedure to M-TURBT for the management of primary large bladder tumours of >3 cm.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 89%

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Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

Mahmoud

Tawfick

Mostafa

et al. 2019

Arab Journal of Urology

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“…With this aim, urologists and anesthesiologists have performed obturator nerve block (ONB) using different methods. In addition, urologists use different approaches such as bipolar cautery practices, bladder wall injections, and changes of the fluid of transurethral resection (TUR) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

Dağlı¹,

Dadali²

2018

Arch Med Sci Civil Dis

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Introduction: Adductor muscle contraction may develop due to an electrical stimulus during transurethral resection of bladder tumors (TURBT), and thus bladder wall perforation and vessel-nerve injuries may develop. Studies in the literature demonstrated that obturator nerve block (ONB) was performed with high success and low complication rates to prevent adductor muscle contraction by both urologists and anesthesiologists. However, we found no data suggesting how frequently ONB was used in current practice in urology clinics. We aimed to provide data about ONB and other methods used in current practice to prevent adductor spasm developing during TURBT surgery in urology clinics. Material and methods: A 15-item questionnaire investigating the methods and ONB techniques used against adductor spasm during TURBT surgery was posted by email to urologists after being granted ethics board approval. Results: One hundred seventy urologists completed and returned the forms. Urologists frequently used techniques such as lowering the cautery current (77.6%), immediate stepping on, and stepping off the foot switch (45.8%), decreasing the bladder volume (14.1%), and wall injections (4.7%). The ONB was used by 42 (24.7%) urologists and 22 anesthesiologists (12.9%); general anesthesia was preferred more often. No significant difference was detected in the comparison of the ONB methods or the institutions of the urologists (p = 0.51) and anesthesiologists (p = 0.07). Conclusions: Urologists used different practices in accordance with their personal skills in the prevention of adductor muscle contraction in TURBT procedures. The ONB was preferred less and used less than general anesthesia and muscle relaxants by both urologists and anesthesiologists.

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“…Ozer et al [11] found a statistically significant difference in the incidence of obturator reflex and bladder perforation. In contrast to the aforementioned studies, however, they found that this complication had a higher incidence with the use of bipolar diathermy.…”

Section: Preventing “Obturator Jerk”mentioning

confidence: 99%

Avoiding the Obturator Jerk during TURBT

Panagoda¹,

Vasdev²,

Gowrie‐Mohan³

2018

Current Urology

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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.

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Bladder injury secondary to obturator reflex is more common with plasmakinetic transurethral resection than monopolar transurethral resection of bladder

Cited by 20 publications

References 12 publications

Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

Avoiding the Obturator Jerk during TURBT

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