The effect of obturator nerve blockade on oncological outcomes of
patients with lateral wall localized non-muscle invasive bladder cancer
Abstract
Objective: To investigate the effect of obturator nerve blockade on
oncological outcomes of patients with a diagnosis of lateral wall
localized non-muscle invasive bladder cancer. Materials and Methods: One
hundred six patients diagnosed with lateral wall localized non-invasive
bladder cancer were evaluated between January 2015 and March 2020 in
this retrospective, cross-sectional observational study. The patients
were divided into two groups: patients receiving only spinal anaesthesia
and those receiving spinal anaesthesia combined with ultrasound-guided
obturator nerve blockade. Oncological outcomes of the groups were
compared statistically. Results: We observed recurrent tumours in 25
patients (45.5%) in Group 1 and 11 patients (21.6%) in Group 2. In
addition, we observed tumour progression in eight patients (14.5%) in
Group 1 and two patients (3.9%) in Group 2. We observed statistical
significance in differences between groups regarding tumour size,
recurrence rate, adequate muscle tissue sampling, the ability for
complete resection and persistent obturator reflex. The efficacy rate of
obturator blockade was 92.1% in Group 2. One-year recurrence-free
survival (RFS) was 98.0% and five-year RFS was 23.5% for Group 1,
while they were, respectively, 97.4% and 57.2% for Group 2.
Conclusion: The obturator reflex is a common and challenging reflex that
may cause major complications and result in unintended consequences such
as incomplete resection or tumour recurrence with transurethral
resection of bladder tumours. In this study, we demonstrated that
combining spinal anaesthesia with obturator nerve blockade for lateral
wall localized non-muscle invasive bladder cancer may prevent tumour
recurrence and reduce perioperative complications.