Safety Study of Bipolar Versus Monopolar Transurethral Resection of Bladder Tumors

Transurethral Resection of Bladder Tumors Without Obturator Nerve Block or Relaxation: Extent of Adductor Muscle Contraction With Monopolar Versus Bipolar Resection Technique

This is a single-center, prospective, randomized, controlled trial comparing two established transurethral electrical resection methods of urinary bladder tumors regarding their risk of stimulating the obturator nerve. One of the major safety issues with transurethral resection is bladder perforation as a consequence of obturator nerve stimulation followed by muscle contraction of. This is mostly a risk of resection of lateral bladder wall tumors near the course of the obturator nerve. It has been advocated that bipolar may be superior to monopolar resection, based on its different electrical properties. This is an important safety aspect for the patient. Main study question: In patients with lateral wall urinary bladder tumors, is bipolar superior to monopolar transurethral electroresection regarding risk of stimulation of the obturator nerve without preoperative nerve block?

urinary bladder neoplasm, bipolar transurethral resection, monopolar transurethral resection, obturator nerve

PlasmaKinetic resectoscope, Gyrus PlasmaKinetic SuperPulse generator (Gyrus Medical Inc., Maple Grove, USA), Fresenius Natriumchlorid 9,0g/l (Fresenius Kabi AG, Homburg, Germany)

Lateral wall urinary bladder tumors are resected transurethrally without obturator nerve block or relaxation under general anesthesia. If resection not possible because of adductor muscle contraction, patients undergo relaxation.

Resectoscope Model 27050 (Karl Storz GmbH & Co. KG, Tuttlingen, Germany), Erbotom ICC 350 (Deltamed-ERBE AG,Winterthur, Switzerland), Purisole®SM (Fresenius Kabi AG, Homburg, Germany)

Lateral wall urinary bladder tumors are resected transurethrally without obturator nerve block or relaxation under general anesthesia. If resection is not possible because of adductor muscle contraction, patients are treated by bipolar resection. If this is still not possible, they undergo relaxation.

Successful resection of the neoplasm without relevant stimulation of the obturator nerve and consecutive contraction of the ipsilateral adductor muscles

Degree of severity of the complications (perforation of the bladder, intraoperative bleeding, postoperative bleeding, others) according to the Clavien-classification

Inclusion Criteria: neoplasms of the lateral wall of the urinary bladder (laterally to the corresponding ostium) operability given based on general medical condition informed consent Exclusion Criteria: antiplatelet drugs stopped <7days (except acetylsalicylate <= 100mg p.o. qd) prothrombine time <70% age <18 years patronized Patients pregnancy severe poor medical condition

Gramann T, Schwab C, Zumstein V, Betschart P, Meier M, Schmid HP, Engeler DS. Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique-a prospective randomised study. World J Urol. 2018 Jul;36(7):1085-1091. doi: 10.1007/s00345-018-2248-0. Epub 2018 Mar 1.