COMPARISON OF INTRAOPERATIVE SAFETY OF BIPOLAR VERSUS MONOPOLAR TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT) IN TERMS OF OBTURATOR NERVE REFLEX (ONR) AND BLADDER PERFORATION

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Abstract

ABSTRACT
Cystoscopy and transurethral resection of bladder tumor (TURBT) is mainstay surgical treatment for initial diagnosis
and evaluation of extent of tumor into detrusor muscle for staging.TURBT is performed with monopolar cautery system.
The close proximity of obturator nerve in inferio-lateral wall of bladder poses significant danger during resection of
laterally placed bladder tumor as electric current can easily stimulate the nerve and cause adductor reflex. Obturator
nerve reflex (ONR) at times causes grave intraoperative complications in terms of bladder wall perforation, excessive
bleeding, resection abandonment and thus incomplete resection and longer hospital stay.
Objectives: To compare bipolar versus monopolar transurethral resection of bladder tumor in term of obturator nerve
reflex and jerk related perforation.
Material and Methods: This randomized control trail was performed at institute of kidneys diseases from January 2013
to January 2014. Total of 100 patients randomized into monopolar and bipolar transurethral resection of bladder tumor.
Intraoperative parameters of active obturator jerk (ONR) and jerk related perforations in two groups were analyzed.
Results: Total of 100 resections done during Jan 2013 to Jan 2014, were randomized into two groups. The mean age of
patients in group 1 (B-TURBT) 58 years, while mean age in group 2 (M-TURBT) was 59 years. In bipolar TURBT group
only 4 patients had active obturator nerve reflex while 46resections were event less .On other hand active obturator reflex
was observed in 14(28%) patient in monopolar TURBT group, while no such jerk observed in 36patients while doing
resection on lateral bladder wall in monopolar group. Obturator jerk related perforation necessitating abandonment of
procedure happened in 4 patients in M-TURBT group.
Conclusion: Bipolar transurethral resection of bladder tumor is associated with lower incidence of obturator reflex and
jerk related bladder perforation compared to monopolar resection.
Key words: Trans Urethral Resection Of Bladder Tumor (TURBT), Obturator Nerve Reflex (ONR)Bipolar

Authors: 
Mohammad Asad Shamsher
Bakhtawar Gul
Riaz Ahmad Khan
Journal Issue: 

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