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MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence

Year 2019, Volume: 9 Issue: 2, 95 - 101, 28.06.2019

Abstract

ÖZET
Amaç: Mesane yan duvar tümörlerinin transüretral rezeksiyonu (TUR-M) sırasında spinal anestezi uygulanan
hastalarda, obturator sinir bloğu (OSB) ile kombine edilenler ve edilmeyenler arasında; alınan patolojik
spesmende detrusor kas dokusunun varlığı ve takip süreleri içerisinde tümör rekürrens zamanı, obturator
refleks ve mesane perforasyonu açısından anlamlı fark olup olmadığının araştırılması.
Gereç ve yöntemler: Ocak 2013-Eylül 2018 tarihleri arasında kliniğimizde spinal anestezi altında mesane
yan duvarı tümörü nedeniyle TUR-M uygulanan 66 hasta retrospektif olarak incelendi. Hastalar iki gruba
ayrıldı. 36 hastaya sadece spinal anestezi, 30 hastaya OSB ile kombine spinal anestezi uygulandı. OSB grubundaki
hastalara inguinal OSB işlemi, spinal anestezi sonrasında periferik sinir stimülatörü ile adduktor
kas kontraksiyonunun devam ettiği bölge tespit edildikten sonra 15 ml %0.25 bupivakain ile blok yapıldı.
Bulgular: OSB yapılmayan grupta obturator refleksi çok anlamlı olarak fazla gözlendi (p<0.01). OSB grubunda
detrusor kas dokusunun varlığı anlamlı derecede yüksekti (p<0.05). Postoperatif nüks oranı ve nüks
süresi açısından, her iki grup arasında anlamlı fark yoktu (p>0.05). Mesane perforasyonu açısından gruplar
arasında fark izlenmedi (p>0.05).
Sonuç: Spinal anestezi ile OSB’nin kombine edilmesi mesane yan duvarı tümörlerinin tedavisinde TURM’nin
komplet rezeksiyon başarısını artırmaktadır. OSB, uygulanma imkanı olan kliniklerde komplet rezeksiyon
başarısını arttırmak amacıyla spinal anesteziye ek olarak önerilebilir.
Anahtar Kelimeler: Detrüsör kas dokusu; Mesane tümörü;Obturator blok; TUR-M
ABSTRACT
Objectives: To investigate presence of detrusor muscle tissue in pathological specimens and time to
recurrence during follow-up, and whether there is significant difference in obturator reflex between
patients underwent spinal anesthesia with or without obturator nerve block (ONB) during transurethral
resection of bladder lateral wall tumor (TUR-BT).
Material and Methods: We retrospectively reviewed 66 patients, who underwent TUR-BT for bladder
lateral wall tumor under spinal anesthesia between January, 2013 and September, 2018. The patients were
classified into two groups. Spinal anesthesia was performed in 36 patients while spinal anesthesia plus
ONB was performed in 30 patients. In ONB group, inguinal ONB was performed by 0.25% bupivakain(15
ml) after identifying the region with ongoing adductor muscle contraction via peripheral nerve stimulator
after spinal anesthesia.
Results: The obturator reflex was significantly higher by spinal anesthesia alone group (p<0.01). In OSB
group, presence of detrusor muscle was significantly greater (p<0.05). There was no significant difference
in postoperative recurrence and time to recurrence between groups (p>0.05). No significant difference was
detected in bladder perforation (p>0.05).
Conclusion: Combination of spinal anesthesia with ONB increases success in complete resection in
the treatment of bladder lateral wall tumors by TUR-BT. Addition of ONB to spinal anesthesia could be
recommended in order to enhance success in complete resection.
KeyWords: Detrusormuscle; Bladdertumors; Obturatornerveblock; TUR-BT

References

  • 1.Siegel RL, Miller KD, Jemal A. Cancerstatistics 2017. CA Cancer J Clin 2017;67(1):7–30. 2.Mydlo JH, Weinstein R, Shah S, Solliday M, Macchia RJ. Long term consequences from bladder perforation and/or violationin the presence of transitional cell carcinoma: results of a small series and a review of the literature. J Urol. 1999;161:1128-32. 3.Jancke G, Rosell J, Jahnson S. Residual tumor in the marginal resection after a complete transurethral resection is associated with local recurrence in Ta/T1 urinary bladder cancer. Scand J Urol Nephrol. 2012;46:343-7. 4.Mariappan P, Zachou A, Grigor KM. Detrusormuscle in the first, apparently complete transurethral resection of bladder tumor specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol. 2010;57:843-9. 5.Divrik RT, Yildirim U, Zorlu F, Ozen H. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomised clinicaltrial. J Urol. 2006;175:1641-4. 6.Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, et al. EAU guidelines on non-muscle invasive urothelial carcinoma of the bladder the 2011 update. EurUrol. 2011;59:997-1008. 7.Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, et al. Variability in therecurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol. 2002;41:523-31. 8.Maruniak NA, Takezawa K, Murphy WM. Accurate pathological staging of urothelial neoplasms requires beter cystoscopic sampling. J Urol. 2002;167:2404-7. 9.Capogrosso P, Capitanio U, Ventimiglia E, Boeri L, Briganti A, Colombo R, et al. Detrusor muscle in TUR derived bladder tumor specimens: can we actually improve the surgical quality? J Endourol. 2016;4:400-5. 10.Creevy CD. Preventing stimulation of the obturator nevre during transurethral resection. J Urol.1969;101:368.
Year 2019, Volume: 9 Issue: 2, 95 - 101, 28.06.2019

Abstract

References

  • 1.Siegel RL, Miller KD, Jemal A. Cancerstatistics 2017. CA Cancer J Clin 2017;67(1):7–30. 2.Mydlo JH, Weinstein R, Shah S, Solliday M, Macchia RJ. Long term consequences from bladder perforation and/or violationin the presence of transitional cell carcinoma: results of a small series and a review of the literature. J Urol. 1999;161:1128-32. 3.Jancke G, Rosell J, Jahnson S. Residual tumor in the marginal resection after a complete transurethral resection is associated with local recurrence in Ta/T1 urinary bladder cancer. Scand J Urol Nephrol. 2012;46:343-7. 4.Mariappan P, Zachou A, Grigor KM. Detrusormuscle in the first, apparently complete transurethral resection of bladder tumor specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol. 2010;57:843-9. 5.Divrik RT, Yildirim U, Zorlu F, Ozen H. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomised clinicaltrial. J Urol. 2006;175:1641-4. 6.Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, et al. EAU guidelines on non-muscle invasive urothelial carcinoma of the bladder the 2011 update. EurUrol. 2011;59:997-1008. 7.Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, et al. Variability in therecurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol. 2002;41:523-31. 8.Maruniak NA, Takezawa K, Murphy WM. Accurate pathological staging of urothelial neoplasms requires beter cystoscopic sampling. J Urol. 2002;167:2404-7. 9.Capogrosso P, Capitanio U, Ventimiglia E, Boeri L, Briganti A, Colombo R, et al. Detrusor muscle in TUR derived bladder tumor specimens: can we actually improve the surgical quality? J Endourol. 2016;4:400-5. 10.Creevy CD. Preventing stimulation of the obturator nevre during transurethral resection. J Urol.1969;101:368.
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Details

Primary Language Turkish
Journal Section Original Research
Authors

Mümtaz Dadalı

Erol Erşekerci This is me

Publication Date June 28, 2019
Published in Issue Year 2019 Volume: 9 Issue: 2

Cite

APA Dadalı, M., & Erşekerci, E. (2019). MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence. Bozok Tıp Dergisi, 9(2), 95-101.
AMA Dadalı M, Erşekerci E. MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence. Bozok Tıp Dergisi. June 2019;9(2):95-101.
Chicago Dadalı, Mümtaz, and Erol Erşekerci. “MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence”. Bozok Tıp Dergisi 9, no. 2 (June 2019): 95-101.
EndNote Dadalı M, Erşekerci E (June 1, 2019) MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence. Bozok Tıp Dergisi 9 2 95–101.
IEEE M. Dadalı and E. Erşekerci, “MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence”, Bozok Tıp Dergisi, vol. 9, no. 2, pp. 95–101, 2019.
ISNAD Dadalı, Mümtaz - Erşekerci, Erol. “MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence”. Bozok Tıp Dergisi 9/2 (June 2019), 95-101.
JAMA Dadalı M, Erşekerci E. MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence. Bozok Tıp Dergisi. 2019;9:95–101.
MLA Dadalı, Mümtaz and Erol Erşekerci. “MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence”. Bozok Tıp Dergisi, vol. 9, no. 2, 2019, pp. 95-101.
Vancouver Dadalı M, Erşekerci E. MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence. Bozok Tıp Dergisi. 2019;9(2):95-101.
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