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.