Transurethral Needle Electrode Resection of Bladder Tumor: A Technique Obtaining En Bloc Resection and Obviating Obturator Nerve Stimulation

Background: Transurethral resection of bladder tumor (TURBT) is the current gold standard for treatment of non-muscle-invasive bladder cancer. However, obturator nerve reflex (ONR) remains as a threat during treating lateral wall tumors. The present study aimed to describe a simple and reliable method which provides  en bloc resection without ONR. Methods: Forty-six patients planned for TURBT with superficial bladder carcinoma nested in lateral bladder wall received transurethral needle electrode resection of bladder tumor (TUNER-BT) under epidural anesthesia without obturator nerve block. Intraoperative and postoperative complications were observed. The resected tissues were examined by a pathologist who recorded grade, invasion of the muscularis propria and the presence of muscular invasion. Results: Tumors were multiple in 11 (24%) patients and single in 35 (76%) patients. Mean tumor size was 1.79 ± 0.43 cm with a mean resection time of 10.8 ± 4.8 minutes. None of the 46 patients developed obturator jerks or perforation. Precise histological evaluation was achieved in all cases: 32.5% pTa, 56.4% pT1, and 11.1% pT2. Conclusions: The needle electrode can be used safely and conveniently during transurethral electroresection of bladder tumors located in the lateral bladder wall. This technique is easy to perform and allows  en bloc resection of tumors. The ONR privilege makes TUNER-BT a preferable option when treating tumors located in lateral bladder wall. World J Nephrol Urol. 2015;4(3):232-236 doi: http://dx.doi.org/10.14740/wjnu221w