A nightmare during endoscopic bladder tumor resection; obturator reflex

Abstract

Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-morbidity if it is not treated early and appropriately. Although there are lots of causes and risks of bladder tumor and it is known that tobacco smoking is the main contributor to bladder tumor, etiology of tumor is not clear. At diagnosis, it is generally seen as a superficial tumor. Transurethral resection of bladder cancer (TUR-B) is the primary surgical method for the diagnosis, staging and treatment of primary or recurrent non-muscle-invasive bladder cancer. In this procedure, different complications may occur, especially bleeding, and the most important complication is bladder perforation. Additional therapies are needed depending on location and size of perforation. An intraperitoneal perforation can lead to laparotomy, bladder repair and open drainage of the abdominal cavity. Sudden adductor muscle spasm can occur when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope, especially when the surgeon is operating at the lateral wall of the bladder, where the obturator nerve runs in close proximity during its intrapelvic course. Therefore, the type of anesthesia is important in the lateral wall tumors of the bladder. Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. We aimed to form a review to reduce difficult situations and to minimize the adverse consequences caused by this reflex that becomes a nightmare in many surgical cases.