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

Abstract

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.

Prediction of the risk of surgical complications in patients undergoing monopolar transurethral resection of bladder tumour – a prospective multicentre observational study

“…In our study, significant obturator nerve reflex was observed in 2% of cases. There are many possible methods to decrease this risk under debate [25]. One of them is the use of bipolar resection instead of monopolar.…”