Results
The mean age of the patients was 64.71 ± 11.70 years. The mean follow-up
time was 39.75 ± 14.61 months. There were 85 (80.2%) male patients and
21 (19.8%) females. Patients who underwent re-TUR-BT after an initial
TUR-BT due to incomplete resection or absence of muscle tissue sampling
in the surgical specimens totalled 40 (37.7%). In group 1; while 17
(30.9%) patients underwent Re-TUR-BT, 23 (40.1%) patients underwent
Re-TUR-BT in group 2 (p=0.134). In terms of complications, three
patients (2.8%) had bladder perforation, six patients (5.7%) had
haematuria and 10 patients (9.4%) had cystitis. All patients with
bladder perforation were extraperitoneal and managed with
catheterization. No patients needed open laparotomy for bladder
perforation. No side effects were related to obturator nerve block was
observed during the study.
Group 1 including 55 patients (51.9%) underwent TUR-BT with only spinal
anaesthesia, and group 2 including 51 patients (48.1%) underwent TUR-BT
using spinal anaesthesia combined with ultrasound-guided obturator nerve
blockade. In all, the efficacy rate of the obturator nerve blockade was
92.1%. The patients’ demographic characteristics that were collected
during the first diagnosis are summarized in Table 1. Recurrent tumour
was observed in 25 patients (45.5%) in Group 1 and 11 patients (21.6%)
in Group 2. In addition, tumour progression was observed in eight
patients (14.5%) in Group 1 and two patients (3.9%) in Group 2. For
all patients, the 1-year overall recurrence-free survival (RFS) was
99.0%, while the overall 5-year RFS was 49.3%. In Group 1, the 1-year
RFS was 98.0% and the 5-year RFS was 23.5%. In Group 2, the 1-year and
5-year RFSs were 97.4% and 57.2%, respectively (Fig. 2). Single-dose
adjuvant chemotherapy was administered to 22 patients (40.0%) in Group
1 and 18 patients (35.3%) in Group 2. Adjuvant intravesical
immunotherapy was administered to 20 patients (36.4%) in Group 1 and 21
patients (41.2%) in Group 2. Maintenance immunotherapy could be
completed in 14 patients (25.5%) in Group 1 and 10 patients (19.6%) in
Group 2. While no death due to bladder cancer was observed in our study,
one patient died due to acute myocardial infarction. Oncological
outcomes of the groups are summarized in Table 2. Statistical
significance was observed in differences between the groups in terms of
tumour size, recurrence rate, adequate muscle tissue sampling, ability
to complete resection and persistent obturator reflex. In the Spearman’s
correlation analysis, we observed a positive correlation between
obturator nerve blockade and tumour size, adequate muscle tissue
sampling and ability to complete resection. There were also negative
correlations between obturator nerve blockade and tumour recurrence and
persistent obturator reflex (Table 3). On multivariate analysis after
age, gender, presence of muscle tissue on the surgical specimen,
presence of complete or incomplete resection, tumor size, tumor number,
pathological T stage, tumor grade and obturator blockade were adjusted
as a confounding factors for tumor recurrence and progression, while
gender (p:0.011, OR:4.12, 95% CI: 1,37-12,35) and obturator nerve
blockade (p:0.049, OR:0.35, 95% CI:0.12-0.99) were independent risk
factor for tumor recurrence, gender and obturator nerve blockade were
not independent risk factor in terms of tumor progression.