MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence

Year 2019, Volume: 9 Issue: 2, 95 - 101, 28.06.2019

Mümtaz Dadalı , Erol Erşekerci

Abstract

ÖZET

Amaç: Mesane yan duvar tümörlerinin transüretral rezeksiyonu (TUR-M) sırasında spinal anestezi uygulanan

hastalarda, obturator sinir bloğu (OSB) ile kombine edilenler ve edilmeyenler arasında; alınan patolojik

spesmende detrusor kas dokusunun varlığı ve takip süreleri içerisinde tümör rekürrens zamanı, obturator

refleks ve mesane perforasyonu açısından anlamlı fark olup olmadığının araştırılması.

Gereç ve yöntemler: Ocak 2013-Eylül 2018 tarihleri arasında kliniğimizde spinal anestezi altında mesane

yan duvarı tümörü nedeniyle TUR-M uygulanan 66 hasta retrospektif olarak incelendi. Hastalar iki gruba

ayrıldı. 36 hastaya sadece spinal anestezi, 30 hastaya OSB ile kombine spinal anestezi uygulandı. OSB grubundaki

hastalara inguinal OSB işlemi, spinal anestezi sonrasında periferik sinir stimülatörü ile adduktor

kas kontraksiyonunun devam ettiği bölge tespit edildikten sonra 15 ml %0.25 bupivakain ile blok yapıldı.

Bulgular: OSB yapılmayan grupta obturator refleksi çok anlamlı olarak fazla gözlendi (p<0.01). OSB grubunda

detrusor kas dokusunun varlığı anlamlı derecede yüksekti (p<0.05). Postoperatif nüks oranı ve nüks

süresi açısından, her iki grup arasında anlamlı fark yoktu (p>0.05). Mesane perforasyonu açısından gruplar

arasında fark izlenmedi (p>0.05).

Sonuç: Spinal anestezi ile OSB’nin kombine edilmesi mesane yan duvarı tümörlerinin tedavisinde TURM’nin

komplet rezeksiyon başarısını artırmaktadır. OSB, uygulanma imkanı olan kliniklerde komplet rezeksiyon

başarısını arttırmak amacıyla spinal anesteziye ek olarak önerilebilir.

Anahtar Kelimeler: Detrüsör kas dokusu; Mesane tümörü;Obturator blok; TUR-M

ABSTRACT

Objectives: To investigate presence of detrusor muscle tissue in pathological specimens and time to

recurrence during follow-up, and whether there is significant difference in obturator reflex between

patients underwent spinal anesthesia with or without obturator nerve block (ONB) during transurethral

resection of bladder lateral wall tumor (TUR-BT).

Material and Methods: We retrospectively reviewed 66 patients, who underwent TUR-BT for bladder

lateral wall tumor under spinal anesthesia between January, 2013 and September, 2018. The patients were

classified into two groups. Spinal anesthesia was performed in 36 patients while spinal anesthesia plus

ONB was performed in 30 patients. In ONB group, inguinal ONB was performed by 0.25% bupivakain(15

ml) after identifying the region with ongoing adductor muscle contraction via peripheral nerve stimulator

after spinal anesthesia.

Results: The obturator reflex was significantly higher by spinal anesthesia alone group (p<0.01). In OSB

group, presence of detrusor muscle was significantly greater (p<0.05). There was no significant difference

in postoperative recurrence and time to recurrence between groups (p>0.05). No significant difference was

detected in bladder perforation (p>0.05).

Conclusion: Combination of spinal anesthesia with ONB increases success in complete resection in

the treatment of bladder lateral wall tumors by TUR-BT. Addition of ONB to spinal anesthesia could be

recommended in order to enhance success in complete resection.

KeyWords: Detrusormuscle; Bladdertumors; Obturatornerveblock; TUR-BT

Keywords

MESANE YAN DUVAR TÜMÖRLERİNİN TRANSÜRETRAL REZEKSİYONU SIRASINDA OBTURATOR SİNİR BLOĞUNUN; TÜMÖR ÖRNEKLERİNDE DETRUSOR KASI VARLIĞI VE HASTALIĞIN NÜKSETMESİ ÜZERİNE ETKİSİ Effect of Obturator Nerve Block During Transurethral Resection of Bladder Lateral Wall Tumors on Presence of Detrusor Muscle in Tumor Samples and Recurrence

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