1Department of Urology, General Hospital of PLA, Beijing 100853, China; 2Department of Urinary Surgery, Affiliated Hospital of Guangdong Medical College
Abstract：Objective:To investigate the feasibility of obviating the obturator nerve reflex during transurethral needle electrode resection of bladder tumors (TUNER-BT). Methods:This series included 12 patients with bladder tumors located in the lateral bladder wall with 1-4 cm in diameter. The patients received epidural anesthesia. After electrocautery of the bladder mucosa 1 cm away from the tumor base by coagulation current, the needle tip was inserted into the muscle layer and the muscle fiber was stretched away from the lateral bladder wall, followed by electroresection current, until the outer semitransparent connective tissue was exposed. Then the tumor as well as its basement was dissected in the plane between the muscular layer and the connective tissue. The specimens containing the tumor and full thickness of the bladder wall were obtained for pathological inspection. The operation time, obturator nerve reflex, peri-operative complications, and pathologic stage of the tumor were observed. Results:Twelve bladder tumors were resected with the operative time of 3-30 min per tumor [range, (12.7±10.4) min]. Obturator nerve blockade was not necessary in any case and no obturator nerve reflex occured. Peri-operative blood loss was minimal. The urine drainage retained 3-7 days. The pathologic stage of the tumors resected showed 6 tumors in T1 stage, 4 tumors in T2a stage, and 2 tumors in T2b stage. Conclusions:TUNER-BT is accompanied by advantages such as precise resection, minimal blood loss, and en bloc specimen. TUNER-BT provides a novel and reliable technique by obviating the obturator nerve stimulation during treatment of bladder tumors located in the lateral bladder wall.
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