Operation mode to prevent obturator nerve reflex in plasmakinetic resection of bladder tumor

Abstract

Objective To observe the results and reality of transurethral resection of bladder tumor with preexcitation of electric cutting loop in the prevention of obturator nerve reflex. Methods The clinical data of 186 patients with bladder tumors admitted from January 2015 to August 2018 were retrospectively analyzed. There were 112 males and 74 females aged 35 to 83 years, average(59±11)years. 76 patients were admitted because of intermittent gross hematuria and 110 patients were admitted because of physical check-up. All patients underwent ultrasound, CT (plain scan/enhancement) and cystoscopy before operation. The pathological diagnosis of cystoscopy biopsy was bladder urothelial cell carcinoma.There were 105 cases clinical stage Ta stage, 81 cases of T1 stage. There were 103 single cases and 39 multiple cases of non-muscular invasive bladder. According to the different surgical techniques, the patients were divided into two groups: the pre-excitation group and lateral incision group. There were 142 cases in pre-excitation group. In the pre-excitation group, the tumors were removed routinely by the resection ring. When the resection ring was far away from the tumors, the pedal switch was pressed to excite the resection ring. The resection ring was moved to the location of the tumors, and the tumors were cut to the muscular layer. The operation was completed after 2 cm electric cauterization around the wound and hemostasis. In the lateral incision group, the tumors were removed routinely by the electric resection ring. The operation time, incidence of obturator nerve reflex, incidence of bladder perforation, amount of bleeding, retention time of catheter, pathological grading, risk grading, hospitalization time and recurrence rate of tumors at 6 months after operation were compared between the two groups. Results The operation was successfully completed in both groups, and there was no transition to open operation. In the pre-excitation group, the operation time was 10 minutes to 56 minutes, with an average of (28±12) minutes, and the intraoperative blood loss ranged from 5 ml to 70 ml, with an average of (35±15) ml. In the lateral incision group, the operation time was 15 minutes to 65 minutes, with an average of (28±11) minutes, and the blood loss was 10 ml to 80 ml, with an average of (40±15) ml. There was no significant difference in operation time and blood loss between the two groups (P>0.05). There were only 3 cases of obturator nerve reflex in preexcitation group, the incidence was 2.1%. There were 13 cases of obturator nerve reflex in lateral resection group, the incidence was 29.5%. There was significant difference of nerve reflex incidence between the two groups (P<0.05). Conclusions In transurethral resection of bladder tumors, the method of pre-excitation of plasma resection ring can effectively decrease obturator nerve reflex and make the operation safer. Key words: Bladder tumors; Plasmakinetic resection of bladder tumor; Obturator nerve reflex