Login to Access Video or Poster Abstract: MP52-12
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Introduction

The lateral bladder wall harbors 46.8% of all bladder tumors. Transurethral resection of bladder tumor (TURBT) in these cases remain as a challenge because adductor muscle spasm often occurred. Bladder perforation, bleeding, incomplete resection, and extravesical spread of tumor are major risks of this reflex. TURBT is performed conventionally with an electrocautery loop. The piecemeal resection specimens are inappropriate for pathological evaluation. Obturator nerve block (ONB) can prevent obturator jerks with various success rates. However,insufficient ONB often occurred.There is urgent need to investigate a reliable method to resect tumors nested in lateral bladder wall. In this study we achieved this goal by accurate transurethral resection of bladder tumor (ATURBT).

Methods

This study includes 42 males and 23 females. Mean patient age was 61.1±16.2 years. Only tumors nested in the lateral bladder wall were recorded and tumors > 2.5 cm in diameter were excluded. ATURBT was performed using a plasma kinetic needle electrode under subdural anesthesia without ONB. After electrocautery of the bladder mucosa by coagulation current, the needle was then inserted into the muscle layer and the muscle bundles were stretched away from the lateral bladder wall, followed by cutting with the electroresection current. The tumor as well as its base was dissected bluntly with the needle. The intact tumor specimen was retrieved through the resectoscope sheath and sent for pathological examination. Postoperative bladder irrigation was not performed unless hematuria occurred. Catheter was removed within 2 days after operation. Intravesical perfusion with epirubicin or BCG was applied once or weekly for 8 weeks after operation, followed by monthly maintenance to 12 months.

Results

65 patients with tumors located in the lateral bladder wall received ATURBT under epidural anasthesia without any obturator nerve block. 76 tumors were resected with diameter of 0.5-2.5 cm (mean1.9±0.4 cm). The resection time of one tumor was 1-10 min (mean 4.3±2.4 min). No obturator nerve reflex occurred. No bladder wall perforation or severe bleeding occurred. Precise TNM stage were obtained, including 36% pTa, 54% pT1, and 10% pT2. 4 cases had tumor recurrence during a mean follow-up of 28.6 (9-38)months. No recurrence at the resection site occurred.

Conclusions

ATURBT can resect tumors located in the lateral bladder wall without obturator nerve reflex. The en bloc specimen helps to make accurate pathological diagnosis.

Funding

none