Effectiveness and Safety of a Modified Technique of Transvesical Obturator Nerve Block to Avoid Adductor Contractions during Transurethral Resection of Bladder Tumors

<b><i>Introduction:</i></b> The aim of the study was to evaluate the effectiveness of a modified transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and consecutive bladder perforations (BPs) during transurethral resection of bladder tumors (TURBTs). <b><i>Materials and Methods:</i></b> A retrospective analysis of all patients resected in 2014–2015 due to a bladder tumor of the lateral walls, including a follow-up period until December 2018, was performed. Two groups were defined: in the first group, all patients underwent TURBT with a modified transvesical ONB. The second group underwent conventional TURBT with intermittent resection. Primary endpoints were the rates of adductor contractions and BPs. <b><i>Results:</i></b> Ninety-four out of 1,145 resected patients presented with tumors on the lateral wall of the bladder and a complete dataset including a long-term follow-up. Thirty-six patients were treated in the ONB group, and 58 patients comprised the control group. The median age in the 2 groups was 70.8 and 71.8 years in the first and second groups, respectively. Adductor spasms were reported in 8.33 versus 25.86% (<i>p</i> = 0.057) and perforation in 2.78 versus 17.24% (<i>p</i> = 0.047) in groups 1 and 2, respectively. After a median follow-up of 32.5 months, there was no significant difference in recurrence rates (52.78 vs. 51.72%, <i>p</i> = 0.672). In a subgroup analysis, lower perforation rates were recorded for the ONB group in patients with tumors &#x3c;3 cm (0/30 vs. 8/46, <i>p</i> = 0.076) and in patients with unifocal tumors (0/12 vs. 5/23, <i>p</i> = 0.141). <b><i>Discussion/Conclusion:</i></b> The simplified approach of transvesical ONB demonstrated in this study appears to be an inexpensive, safe, effective, and simple-to-use technique.

En bloc transurethral resection of bladder tumors: A review of current techniques

Introduction: Growing interest surrounds the concept of en bloc transurethral resection of bladder tumors (ERBT). Theoretical advantages include improved adherence to oncological principles and potential yield of superior pathological specimens. Multiple ERBT methods exist. This review summarizes the current evidence regarding application of differing techniques and technologies to ERBT. Methods: A systematic review of MEDLINE/EMBASE/Scopus databases was performed, using terms “en bloc,” “ERBT,” “bladder,” and “urinary bladder neoplasm.” Template-based data extraction included technique of ERBT, feasibility, tumor size, activation of obturator nerve reflex, operative complications, detrusor muscle sampling rate, and recurrence data. Results: Multiple approaches to ERBT have evolved, using a variety of energy sources. The feasibility of electrocautery, laser, combined waterjet/electrocautery, and polypectomy snare techniques have been confirmed in achieving ERBT. ERBT appears safe, with a low complication rate. The use of laser energy sources reduces the risk of activating the obturator nerve reflex during lateral wall resections. Otherwise, no energy source is unequivocally superior in achieving ERBT. The rate of detrusor muscle sampling is high with use of ERBT and appears superior to that achieved with conventional TURBT (cTURBT) in multiple comparative studies. A limited number of largely non-randomized trials assess bladder tumor recurrence; current evidence suggests this is similar between ERBT and cTURBT groups. Conclusions: En bloc resection of bladder tumors using a variety of technologies is feasible and safe, with a high detrusor muscle sampling rate. Further research is required to determine whether rates of residual disease or recurrence can be reduced with ERBT vs. cTURBT.

Isolated nerve palsy following insertion of a three-piece inflatable penile prosthesis

Case report of a 57 year-old male who underwent insertion of an inflatable penile prosthesis due to erectile dysfunction, secondary to poorly controlled Type two diabetes and Peyronie’s disease. The surgical procedure was uneventful and there were no immediate post-operative complications. During a routine follow up the patient described problems with the deflation of the implant and severe lower back and leg pain. Diagnostic MRI scans revealed reservoir migration, impingement of the obturator nerve and oedema in the adductor muscle group. The reservoir was initially repositioned, and later on removed due to on-going symptoms.

ANALYSIS OF THE RESULTS OF LASER DESTRUCTION OF THE ARTICULAR BRANCH OF THE OBTURATOR NERVE IN ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE COXARTHROSIS

Цель исследования - анализ результатов использования лазерной деструкции суставной ветви запирательного нерва у пациентов пожилого и старческого возраста с дегенеративным коксартрозом. Проспективно изучены результаты лечения 34 пациентов старше 65 лет c симптоматичным дегенеративным заболеванием тазобедренного сустава (ТБС), имеющим соматические противопоказания к выполнению его тотального эндопротезирования. В обследуемой группе в период с 2017 по 2019 г. проведена лазерная деструкция суставной ветви запирательного нерва (970 нм, частотой 9 Гц и мощностью 3 Вт в суммарной дозе 100 Дж). Средний катамнез наблюдения составил 12 мес. Для оценки эффективности хирургического лечения анализировали динамику уровня болевого синдрома в ТБС по визуально-аналоговой шкале, качества жизни - по анкете SF-36, функционального состояния ТБС - по шкале W.H. Harris и наличие операционных осложнений. В результате установлено, что применение лазерной деструкции суставной ветви запирательного нерва при дегенеративном коксартрозе у пациентов пожилого и старческого возраста (при невозможности проведения тотального эндопротезирования ТБС) позволило значительно снизить уровень дооперационного болевого синдрома, восстановить качество жизни и улучшить функциональное состояние пациентов при низком риске развития неблагоприятных последствий. The aim of the study was to analyze the results of the use of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis. The results of treatment of 34 patients over 65 years of age with symptomatic degenerative diseases of the hip joint (HJD) and somatic contraindications for total hip arthroplasty have been prospectively studied. In the study group, in the period from 2017 to 2019, laser destruction of the articular branch of the obturator nerve (970 nm, frequency 9 Hz and power 3 W in a total dose of 100 J) was carried out. The average follow-up was 12 months. To assess the effectiveness of surgical treatment, the dynamics of the pain syndrome in the hip joint was analyzed according to the visual analogue scale, the quality of life according to the SF-36 questionnaire, the functional state of the hip joint according to the W.H. Harris scale and the presence perioperative surgical complications. As a result, it was found that the use of laser destruction of the articular branch of the obturator nerve in degenerative coxarthrosis in elderly and senile patients (if total hip arthroplasty was not possible) made it possible to significantly reduce the level of preoperative pain syndrome, restore the quality of life and improve the functional state of patients with low risks of surgical complications.

A Case Report of Femoral Hematoma following Obturator Nerve Block

Background. When an obturator nerve block (ONB) is performed, the conventional landmark method or ultrasound-guided method is used. The major complications of this block are hematoma, but there are very few reports of its complications. We encountered massive bleeding and a huge hematoma after ONB. Case Presentation. A 95-year-old female underwent transurethral resection of the bladder tumor. Induction of anesthesia was accomplished via spinal anesthesia and right ONB using the landmark method. Postoperatively, subcutaneous bleeding was detected in the lower right interior thigh. Concentrated red cell transfusion was conducted to address the anemia. There was no subsequent expansion of the hematoma. It resolved on postoperative day (POD) 53. The hematoma was deemed to be inadvertently introduced due to an obturator artery puncture during the obturator nerve block. Conclusions. Close attention is necessary to avoid advancing the needle too deep into the obturator during obturator nerve block.

Fuzzy C-Means Algorithm-Based Adoption of Obturator Nerve Block under Adaptive Ultrasound Imaging for Bladder Tumor

This work aimed to study the adoption of obturator nerve block (ONB) based on adaptive medical ultrasound imaging under C-means algorithm in transurethral resection of bladder tumor (TURBT). 120 patients with bladder tumors were diagnosed by C-means algorithm-based ultrasound imaging and were enrolled into group A (epidural anesthesia + resection), group B (general anesthesia), and group C (epidural anesthesia + ONB), each with 40 cases. The accuracy of the detection method, noise level, and complications before and after the operation were compared. All patients received TURBT for treatment. There was no significant difference in the general information of patients in each group ( P > 0.05 ). As a result, the correct segmentation rate of the tumor region segmented by ultrasound imaging by C-means algorithm reached 95.6%. The incidence of obturator nerve reflex (ONR) in group A (7.5%) was greatly inferior to groups B and C ( P < 0.05 ). The length of hospital stay in group A was (4.01 ± 1.43) days, which was notably different from groups B and C, with considerable difference among the three ( P < 0.05 ). In short, the adaptive medical ultrasound imaging under C-means algorithm was more accurate in the diagnosis of bladder tumors. Moreover, ONB can effectively reduce the ONR and the incidence of complications in patients.