"Fatigue": A Simple, Fast And Effective Approach To Prevent Adductor Spasm In The Transurethral Resection Of Bladder Tumour

Background and Purpose: Transurethral resection is of the most appropriate surgical treatment for superficial bladder tumours for its small invasive. In surgical procedures, however, the stimulation to obturator nerve caused by the electrical current will lead violent adductor contraction, which can induce severe complications, such as bladder perforation. Obturator nerve stimulation is more often seen during transurethral resection of a lateral and inferolateral wall of the bladder. This makes the surgery more difficult. To hamper these reaction, Many technique have been proposed since surgery carried out. We herein introduce a new technique named "fatigue" to prevent Obturator nerve reflex. At last we conjecture underlying mechanism of this approach in physiology and electrosurgery.Materials and Methods: We revised 136 patients who underwent transurethral electroresection in our hospital from September 1997 to December 2004 in thisapproach. We collected each case history including gender, age, clinical symptom, imaging representation, location, number, extent of tumour, post-operative patho, follow-up data and so forth. In the surgical procedure, Axle-ring-junction of electrosurgical unit touched the tissue with a distance of approximately 1.5cm to the bladder tumour in the coagulation model. We concerned whether the obturator reflex will be induced. If not, stimulated the tissue in cutting model immediately, otherwise, did the same step in coagulation model till reflex diminished. Conventional resection will be evolved as the end step. Comparison with the obturator nerve block was done finally. Results: The whole process was achieved by conventional instrument. The mean of total operation time was 15 to 55 minutes. Within lateral tumour cases, we can see obturator nerve spasms in 109 cases in pre-coagulation period, the number of contraction ranged from 1 to 43. Reflex happened in 22cases in pre-cutting period. In conventional resection, 37 cases had slight adductor contraction which didn't enflence the process of operation, 3 cases had apparent adductor contraction. The tumour were adequately resected without serious complications such as bladder perforation, post-operation bleeding, infection and so on. Compared with the conventional obturator nerve block, "fatigue" has the same effection, More than 97% percent effectiveness was achieved.Conclusions: "Fatigue" as a new approach to preclude the obturator nerve is recommended. It was vertified effectually to avoid bladder peferation during theTUR operation. This technique was conformed relatively simple, fast, effective in clinal cure. Moreover, it's easy to perform for novices.