How safe are bladder lateral wall tumors?

How safe are bladder lateral wall tumors? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article How safe are bladder lateral wall tumors? Mehmet YOLDAS, Cem YUCEL, hakan UCOK, Esat kaan AKBAY, Mahmut can KARABACAK, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6737965/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : The aim of our study was to evaluate and compare the effects of the type of anaesthesia applied during surgery on tumor recurrence and progression in patients with bladder tumors located in the lateral bladder wall Materials and Methods : Patients who underwent primary transurethral resection of a bladder tumor (TUR-BT) due to lateral wall bladder tumors between 2015 and 2020 were retrospectively evaluated. Patients who received spinal anaesthesia with an obturator nerve block (Group 1) and those who received general anaesthesia with a curare (Group 2) were included. After patients with incomplete data, irregular follow-up, recurrent tumors, muscle-invasive pathology, or incomplete resections were excluded, a total of 168 patients with primary lateral wall bladder tumors were included in the final analysis. Results : Group 1 included 102, patients, and Group 2 included 66 patients. The mean follow-up was 67.5 months (range: 60–105) in Group 1 and 69 months (range: 60–107) in Group 2. The five-year recurrence rate was 40%, %18 Group 1 and Group 2. At the same time, the average time to recurrence was 21 months in Group 1 and 31 months in Group 2. Patients in group 2 were found to have less and later bladder tumor recurrence. Conclusion : Although the use of general anaesthesia alone does not seem to influence the long-term recurrence rates of lateral wall bladder tumours, it may have an effect on the time to recurrence and disease progression. Bladder cancer recurrence Bladder cancer progression Obturator nerve block General anaesthesia INTRODUCTION Bladder cancer is the most common genitourinary malignancy in males after prostate cancer. Patients typically present with painless, clotted hematuria [ 1 ]. Bladder tumors are divided into two groups: muscle-invasive and noninvasive. TUR-BT is the primary diagnostic and therapeutic approach in the treatment of this disease However, TUR-BT is not without complications; the most serious of which is bladder perforation during resection. This complication causes resected tumor tissues to leak into the abdominal cavity, increases the risk of TUR syndrome and sometimes results in complete resection, inability to administer intravesical chemotherapy, and potential tumor cell dissemination [ 2 ]. The most common site of bladder perforation due to obturator jerk is the lateral wall [ 3 ]. Electrical stimulation of the obturator nerve, which courses close to the bladder sidewalls during resection, can cause intense adductor muscle contraction in the leg, commonly referred to as “obturator jerk.” This involuntary movement significantly increases the risk of bladder perforation during the procedure. Among patients with NMİBC, one of the most significant challenges is the high rate of tumor recurrence and progression. Various factors contribute to recurrence, but complete resection of the tumor plays a crucial role in minimizing this risk [ 4 ]. Ensuring that both the entire tumor and a sufficient sample of muscle tissue are excised is essential for reducing the likelihood of recurrence and progression [ 4 ]. MATERIALS AND METHODS Ethical approval for this study was given by the local ethics committee of Tepecik Training and Research Hospital. (Date: 07/02/2023, Decision No: 2023/01/09), The Declaration of Helsinki has been complied with. Patients who were newly diagnosed with bladder tumors confined to the lateral bladder wall and underwent TURBT between 2015 and 2020 were included in this study. To ensure a homogeneous study population, individuals with variant pathology, invasion into the muscularis propria (T2 stage), carcinoma in situ (CİS), tumors larger than 3 cm, or multifocal tumors were excluded from the analysis. A total of 168 patients who met the inclusion criteria were divided into groups 1 and 2 according to the type of anaesthesia applied during the operation. Group 1 (n = 102) included patients who underwent spinal surgery with an obturator nevre block (ONB), whereas Group 2 (n = 66) consisted of those who received general anaesthesia (GA) with muscle relaxants. Patients were assigned to Group 2 if they declined spinal anaesthesia, were using anticoagulant medication, had skin infections in the lumbar region, or had contraindications for spinal anaesthesia. All procedures were performed via a 26 French resectoscope with a 30-degree optic lens. Tumor resection was carried out with bipolar cautery, and sampling of the muscular layer was also performed to ensure adequate staging. Within 4 to 6 hours postoperatively, a single intravesical dose of epirubicin (80 mg) was administered. However, patients who were suspected of having bladder perforation during the operation or those who experienced postoperative hematuria were not given intravesical chemotherapy. All patients were monitored postoperatively with flexible cystoscopy at three-month intervals during the first year and subsequently every six months. STATİSTİCAL ANALYSİS Statistical analyses were conducted via SPSS software. Descriptive statistics are presented as the means ± standard deviations. Student’s t test was used to compare variables such as age, weight, tumor size, recurrence time, and follow-up duration. Recurrence rates and one-year recurrence rates were evaluated via the chi-square test, whereas comparisons involving bladder perforation, sex, and ASA scores were performed via Fisher’s exact chi-square test. A p-value of less than 0.05 was considered statistically significant. RESULTS A total of 168 patients were retrospectively reviewed, 102 patients were in Group 1(ONB) and 66 patients were in Group 2(GA). There was no statistically significant difference in demographic data, tumor size or tumor stage between the two groups. However, the presence of muscle tissue in the pathology sample indicated that the quality of TUR BT was a significantly different (P = 0.01). The mean age was 68.2 ± 5.2 years in the ONB group and 65.1 ± 6.1 years in the GA group (P = 0.2). The average BMİ was 26.9 ± 2.3 in Group 1 and 28.1 ± 3.1 in Group 2. Female patients made up 7.8% of the ONB patients and 9% of the GA patients (P = 0.19). The mean tumor size was 2.1 ± 0.7 cm in ONB patients and 1.8 ± 0.9 cm in GA patients (P = 0.127). Approximately 76% of ONB patients and 72% of GA patients had Ta-stage tumors. İntravesical chemotherapy was not administered to 14 patients in Group1 (12 due to suspected bladder perforation and 2 due to hematuria) or to 4 patients in Group 2 (3 due to suspected bladder perforation and 1 due to hematuria). Muscle tissue was identified in the pathological specimens of 83 patients (81%) with ONB and 62 patients (93%) with GA. was significantly different (P = 0.01), indicating a deeper resection in Group 2. Bladder perforation occurred in 12 (11.7%) patients in the SA group. Two of these patients underwent open surgery. Ten patients were followed up with a catheter. İt occurred in 3 patients in the GA group. All patients were followed conservatively with Foley catheter. The risk of perforation was lower in the GA group (P = 0.01) The demographic characteristics and tumor pathology data are presented in Table 1 . Table 1 Demographic data of ONB and GA groups Group 1(102) ONB Group 2(66) GA P value Age (years) 68,2 ± 5,2 65,1 ± 6,1 0,2 Gender Male/Female 94/8 60/6 0,19 Asa score 1/2/3 12/75/14 5/42/19 0,3 Tm size 2,1 ± 0,7 1,8 ± 0,9 0,12 Tm stage Ta/T1 78/24 48/18 0,14 Presence of muscle tissue in specimens 83(%81) 62(%93) 0,01 Bladder perforation 12(%11,7) 3(%4,5) 0,01 Postoperative fever due to atelectasis occurred in two patients. The recurrence rates of bladder tumors were significantly lower in the GA group: At 1 year, the recurrence rate was 23% in Group 1 and 11% in Group 2. At 3 years, the recurrence rate was 29% in Group 1 and 15% in Group 2. At the 5-year follow-up, the recurrence rate was 40% in ONB patients and 18% in GA patients. The P values were 0.03, 0.02, and 0.01 respectively. The tumor recurrence time was 21 months in the ONB group and 31 months in GA the group (p = 0.02). The follow-up time was 78 months in the ONB group and 81 months in the GA group (p = 0.5). Progression was detected in 8 (8%) ONB patients and 2 (3%) GA patients (p = 0.01). The recurrence progression rates are shown in Table 2 . Table 2 patients’ progression and recurrence rates Variables Group 1(102) ONB Group 2(66) GA P value Patients with recurrence at 1 year, no. (%) 23(%23) 7(%11) 0,03 Patients with recurrence at 3 year, no. (%) 30(%29) 10(%15) 0,02 Patients with recurrence at 5 year, no. (%) 41(%40) 12(%18) 0,01 Mean time to recurrence (month) 21 31 0,02 Follow-up period (month) 78 81 0,5 Patients with progression, no. (%) 8(%8) 2(%3) 0,01 DİSCUSSİON TUR BT is a widely performed urological procedure used for the diagnosis and treatment of bladder cancer, and predominantly occurs in the elderly population. Approximately 40% recurrence and 8% progression are observed [ 5 ]. Deep resections performed in TUR BT include tumor tissue extending deeper than the mucosa and affect bladder tumor recurrence and progression rates. The visibility of muscle tissue in the resection specimen reflects the quality of the resection performed [ 6 ]. In our study, the presence of muscle tissue, which determines the quality of TUR BT was 93% greater in the GA group than in the SA group, with a P value of 0.01, which was statistically significant. TUR BT performed under general anaesthesia increases the quality of resection. Tumours located on the lateral walls of the bladder are particularly challenging to resect because of the risk of obturator jerk, which can lead to involuntary adduction movement of the same-sided leg. This reaction can complicate the procedure, potentially leading to insufficient tumor removal or the development of complications [ 7 ]. In our study, the risk of perforation was lower in the GA (P = 0,01), which is consistent with the literature. To reduce obturator jerk, several surgical measures are employed, including shortening the length of resection, reducing the cut and coagulation energy, using bipolar diathermy instead of monopolar diathermy, and avoiding excessive bladder distension. Owing to the fear of obturator jerk, surgical teams may sometimes opt for more superficial resections [ 8 ]. However, superficial resection increases the risk of tumor recurrence and progression. As a result, secondary TURBT is recommended for nonmuscle invasive bladder tumors [ 9 ]. During TURBT, bladder perforation can occur either intra peritoneally or extra peritoneally. The resected tissue may spread outside the bladder due to these perforations. For intraperitoneal perforations, the opposite and upper bladder walls are at risk, whereas for extraperitoneal perforations, the lateral walls and bladder neck are more vulnerable. Urologists should exercise extra caution when performing resections on the lateral bladder walls due to the risk of obturator jerk and should avoid deep resections and excessive cauterization, as these can influence the recurrence and progression of bladder tumors [ 10 ]. In our study, the presence of muscle tissue in the resected specimen, which is an indicator of deep resection, was found to be significantly greater in the GA group. The choice of anaesthesia also plays a crucial role in the success of the procedure. Spinal anaesthesia with an obturator nevre block targets the nevre level, and while it is often effective, it may sometimes fail to block the leg completely. General anaesthesia, combined with muscle relaxants such as curare, works at the muscle level and provides a more reliable block, eliminating the possibility of failure. This allows the surgeon to perform deeper resections and cauterizations with greater precision. Many studies have been conducted to reduce the risk of recurrence and progression of bladder tumors, therefore the importance of deep resection and secondary TUR BT has been repeatedly emphasized [ 11 , 12 ]. In our study, patients who underwent bladder lateral wall tumor resection under general anaesthesia (GA) allowed the surgeons to perform more confident and deeper resections. This group had lower recurrence and progression rates at the 1-year follow-up than did those who underwent surgery with spinal anaesthesia and an obturator nevre block (ONB). Specifically, the recurrence rate in the GA group at the 1-year mark was 11%, whereas it was 25% in the SA ONB group (p = 0.03), which was a statistically significant difference. The GA group had lower recurrence rates during the first year after the operation. Similarly, at the 3rd and 5th year follow-ups, there was a statistically significant difference in the recurrence values ​​in the GA group, with 15% for the 3rd year and 18% for the 5th year, with P values of 0.02 and 0.01, respectively. Typically, removing the tumor tissue in one continuous piece, which is more feasible when the GA is used, is recommended. On the other hand, resections performed with ONB are often fragmented due to anxiety and muscle contractions, which can increase the risk of tumor seeding and subsequent recurrence [ 13 ]. In our patients, the recurrence rates for tumors in the bladder base and trigone region, areas where the surgeon is most confident, were notably lower than those for tumors in other locations. This finding suggests that deeper resections involving the muscular layer, especially in these areas, play a critical role in affecting the progression of the disease. In the GA group, 2 patients (3%) progressed to the T2 stage, whereas in the SA group, 8 patients (8%) progressed to a higher stage, a statistically significant difference (p = 0.01). Although performing TURBT with GA goes against the principles of minimally invasive surgery, it offers advantages by enabling the surgeon to conduct deeper resections and apply thermal energy for cauterization of the tumor bed or surrounding tissue. This approach effectively lowers the risks of tumor recurrence and progression. CONCLUSİON TURBT with GA goes against the principles of minimally invasive surgery, it offers advantages by enabling the surgeon to conduct deeper resections and apply thermal energy for cauterization of the tumor bed or surrounding tissue. This approach effectively lowers the risks of tumor recurrence and progression. Minimally invasive surgical principles should be used without sacred oncological results Declarations Ethics approval and consent to participate This study was approved by the Tepecik Training and Research Hospital Ethics Committee (Decision No: 2023/01/09; Date: 07/02/2023). Informed consent was obtained from all individual participants included in the study. Consent for publication Consent for publication was obtained from all individual participants. Clinical trial registration Not applicable. Funding No funding was received for conducting this study. The authors have no relevant financial or nonfnancial interests to disclose. Data availability No datasets were generated or analysed during the current study. Competing interests The authors declare that they have no competing interests. References Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin . 2021;71(3):209-249. https://doi.org/10.3322/caac.21660 Tekgül ZT, Divrik RT, Turan M, Konyalioglu E, Simsek E, Gönüllü M: İmpact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall. Urol J 2014; 11: 1248–1252 https://doi.org/10.22037/uj.v11i1.1819 Yorulmaz EM, Kose O, Ozcan S, Gorgel SN, Akin Y. Factors İnfluencing Bladder Perforation during Transurethral Resection of Bladder Cancer: A Comprehensive Analysis. ArchEspUrol .2024; 77(5): 471-478. https://doi.org/10.56434/j.arch.esp.urol.20247705.66 Divrik RT, Yildirim U, Zorlu F, Ozen H. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol. 2006; 175: 1641-4. https://doi.org/10.1016/S0022-5347(05)01002-5 Matloubieh JE, Hanelin D, Agalliu I. Comparisons of Intravesical Treatments with Mitomycin C, Gemcitabine, and Docetaxel for Recurrence and Progression of Non-Muscle Invasive Bladder Cancer: Updated Systematic Review and Meta-Analysis. Cancers (Basel) . 2024; 16(24): 4125. https://doi.org/10.3390/cancers16244125 Volz Y, Trappmann R, Ebner B, et al. Absence of detrusor muscle in TUR-BT specimen - can we predict who is at highest risk?. BMC Urol . 2023; 23(1): 106. https://doi.org/10.1186/s12894-023-01278-7 Balbay MD, Cimentepe E, Unsal A, Bayrak O, Koç A, Akbulut Z: The actual incidence of blad-der perforation following transurethral bladder surgery. J Urol 2005; 174: 2260–2262. https://doi.org/10.1097/01.ju.0000181811.61199.35 Panagoda PI, Vasdev N, Gowrie-Mohan S. Avoiding the Obturator Jerk during TURBT. CurrUrol . 2018; 12(1): 1-5. https://doi.org/10.1159/000447223 Yanagisawa T, Kawada T, vonDeimling M, et al. Repeat Transurethral Resection for Non-muscle-invasive Bladder Cancer: An Updated Systematic Review and Meta-analysis in the Contemporary Era. Eur Urol Focus . 2024; 10(1): 41-56. https://doi.org/10.1016/j.euf.2023.07.002 Nicoletti R, Gauhar V, Castellani D, Enikeev D, Herrmann TRW, Teoh JY. Current Techniques for En Bloc Transurethral Resection of Bladder Tumor: A Hands-on Guide Through the Energy Landscape. Eur Urol Focus . 2023; 9(4): 567-570. https://doi.org/10.1016/j.euf.2023.04.007 Culpan M, Kazan O, Acar HC, Iplikci A, Atis G, Yildirim A. The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors. Actas Urol Esp (Engl Ed) . 2022; 46(7): 423-430. https://doi.org/10.1016/j.acuroe.2022.05.001 Akitake M, Yamaguchi A, Shiota M, et al. Predictive Factors for Residual Cancer in Second Transurethral Resection for Non-muscle-invasive Bladder Cancer. Anticancer Res . 2019; 39(8): 4325-4328 https://doi.org/ 10.21873/anticanres.13598 Miyake M, Nishimura N, Inoue T, et al. Fluorescent cystoscopy-assisted en bloc transurethral resection versus conventional transurethral resection in patients with nonmuscle invasive bladder cancer: study protocol of a prospective, open-label, randomized control trial (the FLEBER study). Trials . 2021; 22(1): 136. https://doi.org/10.1186/s13063-021-05094-y Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6737965","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471475485,"identity":"4f9b2fd4-654a-4a8f-b8e7-74e4772389ec","order_by":0,"name":"Mehmet YOLDAS","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYFAC5gYJICnHz97/8TFEgLmBgBZGsBZjyZ4DxsYMDAZALYzEaUnccCPBTBqshYGAFoPjjY03fvwBKruRkFZdUPEnmr8dqOVHxTbcWs4cbLbsbQO6pufBsdszzhjkzjjM2MDYc+Y2bi03EtskeBsY2JjZE9tu87YZ5DYAtTAztuHXIvnnDwMPG0MyWzFIy3xitEgD1UvwcKSxMYO0bCCkRRLoF2vZNgYDCZ4zzNI8Z4xzNwK1HMTnF77jzQdvvvnDUL//eA/jZ54Kudx55w8ffPCjArcWhQNg6j+q6AGc6oFAvgGf7CgYBaNgFIwCEAAAMHdbRHKk2VQAAAAASUVORK5CYII=","orcid":"","institution":"Tepecik Training and Research Hospital Urology Clinic","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"YOLDAS","suffix":""},{"id":471475486,"identity":"43c67628-5edd-4a6e-ae75-5743061186d2","order_by":1,"name":"Cem YUCEL","email":"","orcid":"","institution":"Tepecik Training and Research Hospital Urology Clinic","correspondingAuthor":false,"prefix":"","firstName":"Cem","middleName":"","lastName":"YUCEL","suffix":""},{"id":471475487,"identity":"ff96223a-2ae9-42b3-8541-850de1242149","order_by":2,"name":"hakan UCOK","email":"","orcid":"","institution":"Tepecik Training and Research Hospital Urology Clinic","correspondingAuthor":false,"prefix":"","firstName":"hakan","middleName":"","lastName":"UCOK","suffix":""},{"id":471475488,"identity":"e514b767-ca83-4cea-8f71-d7d678da2b2a","order_by":3,"name":"Esat kaan AKBAY","email":"","orcid":"","institution":"Tepecik Training and Research Hospital Urology Clinic","correspondingAuthor":false,"prefix":"","firstName":"Esat","middleName":"kaan","lastName":"AKBAY","suffix":""},{"id":471475489,"identity":"775ba53c-9029-4b45-be79-34557e20cd03","order_by":4,"name":"Mahmut can KARABACAK","email":"","orcid":"","institution":"Tepecik Training and Research Hospital Urology Clinic","correspondingAuthor":false,"prefix":"","firstName":"Mahmut","middleName":"can","lastName":"KARABACAK","suffix":""},{"id":471475490,"identity":"5c6825fd-01ea-4e31-b4b7-9958bf149701","order_by":5,"name":"Omer KORAS","email":"","orcid":"","institution":"Tepecik Training and Research Hospital Urology Clinic","correspondingAuthor":false,"prefix":"","firstName":"Omer","middleName":"","lastName":"KORAS","suffix":""}],"badges":[],"createdAt":"2025-05-24 08:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6737965/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6737965/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87041017,"identity":"0d73545b-baa6-47c8-8014-2aaf57a15be1","added_by":"auto","created_at":"2025-07-18 13:53:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":539646,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6737965/v1/65096762-0e4e-4791-a821-d421f642ef20.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"How safe are bladder lateral wall tumors?","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBladder cancer is the most common genitourinary malignancy in males after prostate cancer. Patients typically present with painless, clotted hematuria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Bladder tumors are divided into two groups: muscle-invasive and noninvasive. TUR-BT is the primary diagnostic and therapeutic approach in the treatment of this disease However, TUR-BT is not without complications; the most serious of which is bladder perforation during resection. This complication causes resected tumor tissues to leak into the abdominal cavity, increases the risk of TUR syndrome and sometimes results in complete resection, inability to administer intravesical chemotherapy, and potential tumor cell dissemination [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most common site of bladder perforation due to obturator jerk is the lateral wall [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Electrical stimulation of the obturator nerve, which courses close to the bladder sidewalls during resection, can cause intense adductor muscle contraction in the leg, commonly referred to as \u0026ldquo;obturator jerk.\u0026rdquo; This involuntary movement significantly increases the risk of bladder perforation during the procedure.\u003c/p\u003e \u003cp\u003eAmong patients with NMİBC, one of the most significant challenges is the high rate of tumor recurrence and progression. Various factors contribute to recurrence, but complete resection of the tumor plays a crucial role in minimizing this risk [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Ensuring that both the entire tumor and a sufficient sample of muscle tissue are excised is essential for reducing the likelihood of recurrence and progression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eEthical approval for this study was given by the local ethics committee of Tepecik Training and Research Hospital. (Date: 07/02/2023, Decision No: 2023/01/09), The Declaration of Helsinki has been complied with.\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePatients who were newly diagnosed with bladder tumors confined to the lateral bladder wall and underwent TURBT between 2015 and 2020 were included in this study. To ensure a homogeneous study population, individuals with variant pathology, invasion into the muscularis propria (T2 stage), carcinoma in situ (CİS), tumors larger than 3 cm, or multifocal tumors were excluded from the analysis.\u003c/p\u003e \u003cp\u003eA total of 168 patients who met the inclusion criteria were divided into groups 1 and 2 according to the type of anaesthesia applied during the operation. Group 1 (n\u0026thinsp;=\u0026thinsp;102) included patients who underwent spinal surgery with an obturator nevre block (ONB), whereas Group 2 (n\u0026thinsp;=\u0026thinsp;66) consisted of those who received general anaesthesia (GA) with muscle relaxants. Patients were assigned to Group 2 if they declined spinal anaesthesia, were using anticoagulant medication, had skin infections in the lumbar region, or had contraindications for spinal anaesthesia.\u003c/p\u003e \u003cp\u003eAll procedures were performed via a 26 French resectoscope with a 30-degree optic lens. Tumor resection was carried out with bipolar cautery, and sampling of the muscular layer was also performed to ensure adequate staging. Within 4 to 6 hours postoperatively, a single intravesical dose of epirubicin (80 mg) was administered. However, patients who were suspected of having bladder perforation during the operation or those who experienced postoperative hematuria were not given intravesical chemotherapy.\u003c/p\u003e \u003cp\u003eAll patients were monitored postoperatively with flexible cystoscopy at three-month intervals during the first year and subsequently every six months.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSTATİSTİCAL ANALYSİS\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted via SPSS software. Descriptive statistics are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations. Student\u0026rsquo;s t test was used to compare variables such as age, weight, tumor size, recurrence time, and follow-up duration. Recurrence rates and one-year recurrence rates were evaluated via the chi-square test, whereas comparisons involving bladder perforation, sex, and ASA scores were performed via Fisher\u0026rsquo;s exact chi-square test. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 168 patients were retrospectively reviewed, 102 patients were in Group 1(ONB) and 66 patients were in Group 2(GA). There was no statistically significant difference in demographic data, tumor size or tumor stage between the two groups. However, the presence of muscle tissue in the pathology sample indicated that the quality of TUR BT was a significantly different (P\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe mean age was 68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 years in the ONB group and 65.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1 years in the GA group (P\u0026thinsp;=\u0026thinsp;0.2). The average BMİ was 26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 in Group 1 and 28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 in Group 2. Female patients made up 7.8% of the ONB patients and 9% of the GA patients (P\u0026thinsp;=\u0026thinsp;0.19).\u003c/p\u003e \u003cp\u003eThe mean tumor size was 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 cm in ONB patients and 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 cm in GA patients (P\u0026thinsp;=\u0026thinsp;0.127). Approximately 76% of ONB patients and 72% of GA patients had Ta-stage tumors.\u003c/p\u003e \u003cp\u003eİntravesical chemotherapy was not administered to 14 patients in Group1 (12 due to suspected bladder perforation and 2 due to hematuria) or to 4 patients in Group 2 (3 due to suspected bladder perforation and 1 due to hematuria).\u003c/p\u003e \u003cp\u003eMuscle tissue was identified in the pathological specimens of 83 patients (81%) with ONB and 62 patients (93%) with GA. was significantly different (P\u0026thinsp;=\u0026thinsp;0.01), indicating a deeper resection in Group 2. Bladder perforation occurred in 12 (11.7%) patients in the SA group. Two of these patients underwent open surgery. Ten patients were followed up with a catheter. İt occurred in 3 patients in the GA group. All patients were followed conservatively with Foley catheter. The risk of perforation was lower in the GA group (P\u0026thinsp;=\u0026thinsp;0.01)\u003c/p\u003e \u003cp\u003eThe demographic characteristics and tumor pathology data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of ONB and GA groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1(102) ONB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2(66) GA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68,2\u0026thinsp;\u0026plusmn;\u0026thinsp;5,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65,1\u0026thinsp;\u0026plusmn;\u0026thinsp;6,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMale/Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60/6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAsa score 1/2/3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12/75/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/42/19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTm size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,1\u0026thinsp;\u0026plusmn;\u0026thinsp;0,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,8\u0026thinsp;\u0026plusmn;\u0026thinsp;0,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTm stage Ta/T1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78/24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48/18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of muscle tissue in specimens\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(%81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62(%93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBladder perforation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(%11,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(%4,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePostoperative fever due to atelectasis occurred in two patients.\u003c/p\u003e \u003cp\u003eThe recurrence rates of bladder tumors were significantly lower in the GA group:\u003c/p\u003e \u003cp\u003eAt 1 year, the recurrence rate was 23% in Group 1 and 11% in Group 2. At 3 years, the recurrence rate was 29% in Group 1 and 15% in Group 2. At the 5-year follow-up, the recurrence rate was 40% in ONB patients and 18% in GA patients. The P values were 0.03, 0.02, and 0.01 respectively.\u003c/p\u003e \u003cp\u003eThe tumor recurrence time was 21 months in the ONB group and 31 months in GA the group (p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003cp\u003eThe follow-up time was 78 months in the ONB group and 81 months in the GA group (p\u0026thinsp;=\u0026thinsp;0.5).\u003c/p\u003e \u003cp\u003eProgression was detected in 8 (8%) ONB patients and 2 (3%) GA patients (p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe recurrence progression rates are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epatients\u0026rsquo; progression and recurrence rates\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1(102) ONB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2(66) GA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients with recurrence at 1 year, no. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(%23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(%11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients with recurrence at 3 year, no. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(%29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(%15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients with recurrence at 5 year, no. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(%40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(%18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean time to recurrence (month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up period (month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients with progression, no. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(%8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(%3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DİSCUSSİON","content":"\u003cp\u003eTUR BT is a widely performed urological procedure used for the diagnosis and treatment of bladder cancer, and predominantly occurs in the elderly population. Approximately 40% recurrence and 8% progression are observed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Deep resections performed in TUR BT include tumor tissue extending deeper than the mucosa and affect bladder tumor recurrence and progression rates. The visibility of muscle tissue in the resection specimen reflects the quality of the resection performed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In our study, the presence of muscle tissue, which determines the quality of TUR BT was 93% greater in the GA group than in the SA group, with a P value of 0.01, which was statistically significant. TUR BT performed under general anaesthesia increases the quality of resection.\u003c/p\u003e \u003cp\u003eTumours located on the lateral walls of the bladder are particularly challenging to resect because of the risk of obturator jerk, which can lead to involuntary adduction movement of the same-sided leg. This reaction can complicate the procedure, potentially leading to insufficient tumor removal or the development of complications [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In our study, the risk of perforation was lower in the GA (P\u0026thinsp;=\u0026thinsp;0,01), which is consistent with the literature.\u003c/p\u003e \u003cp\u003eTo reduce obturator jerk, several surgical measures are employed, including shortening the length of resection, reducing the cut and coagulation energy, using bipolar diathermy instead of monopolar diathermy, and avoiding excessive bladder distension. Owing to the fear of obturator jerk, surgical teams may sometimes opt for more superficial resections [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, superficial resection increases the risk of tumor recurrence and progression. As a result, secondary TURBT is recommended for nonmuscle invasive bladder tumors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring TURBT, bladder perforation can occur either intra peritoneally or extra peritoneally. The resected tissue may spread outside the bladder due to these perforations. For intraperitoneal perforations, the opposite and upper bladder walls are at risk, whereas for extraperitoneal perforations, the lateral walls and bladder neck are more vulnerable. Urologists should exercise extra caution when performing resections on the lateral bladder walls due to the risk of obturator jerk and should avoid deep resections and excessive cauterization, as these can influence the recurrence and progression of bladder tumors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our study, the presence of muscle tissue in the resected specimen, which is an indicator of deep resection, was found to be significantly greater in the GA group.\u003c/p\u003e \u003cp\u003eThe choice of anaesthesia also plays a crucial role in the success of the procedure. Spinal anaesthesia with an obturator nevre block targets the nevre level, and while it is often effective, it may sometimes fail to block the leg completely. General anaesthesia, combined with muscle relaxants such as curare, works at the muscle level and provides a more reliable block, eliminating the possibility of failure. This allows the surgeon to perform deeper resections and cauterizations with greater precision.\u003c/p\u003e \u003cp\u003eMany studies have been conducted to reduce the risk of recurrence and progression of bladder tumors, therefore the importance of deep resection and secondary TUR BT has been repeatedly emphasized [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our study, patients who underwent bladder lateral wall tumor resection under general anaesthesia (GA) allowed the surgeons to perform more confident and deeper resections. This group had lower recurrence and progression rates at the 1-year follow-up than did those who underwent surgery with spinal anaesthesia and an obturator nevre block (ONB). Specifically, the recurrence rate in the GA group at the 1-year mark was 11%, whereas it was 25% in the SA ONB group (p\u0026thinsp;=\u0026thinsp;0.03), which was a statistically significant difference. The GA group had lower recurrence rates during the first year after the operation.\u003c/p\u003e \u003cp\u003eSimilarly, at the 3rd and 5th year follow-ups, there was a statistically significant difference in the recurrence values ​​in the GA group, with 15% for the 3rd year and 18% for the 5th year, with P values of 0.02 and 0.01, respectively. Typically, removing the tumor tissue in one continuous piece, which is more feasible when the GA is used, is recommended. On the other hand, resections performed with ONB are often fragmented due to anxiety and muscle contractions, which can increase the risk of tumor seeding and subsequent recurrence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our patients, the recurrence rates for tumors in the bladder base and trigone region, areas where the surgeon is most confident, were notably lower than those for tumors in other locations. This finding suggests that deeper resections involving the muscular layer, especially in these areas, play a critical role in affecting the progression of the disease. In the GA group, 2 patients (3%) progressed to the T2 stage, whereas in the SA group, 8 patients (8%) progressed to a higher stage, a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eAlthough performing TURBT with GA goes against the principles of minimally invasive surgery, it offers advantages by enabling the surgeon to conduct deeper resections and apply thermal energy for cauterization of the tumor bed or surrounding tissue. This approach effectively lowers the risks of tumor recurrence and progression.\u003c/p\u003e"},{"header":"CONCLUSİON","content":"\u003cp\u003eTURBT with GA goes against the principles of minimally invasive surgery, it offers advantages by enabling the surgeon to conduct deeper resections and apply thermal energy for cauterization of the tumor bed or surrounding tissue. This approach effectively lowers the risks of tumor recurrence and progression. Minimally invasive surgical principles should be used without sacred oncological results\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Tepecik Training and Research Hospital Ethics Committee (Decision No: 2023/01/09; Date: 07/02/2023). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was obtained from all individual participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study. The authors have no relevant financial or nonfnancial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. \u003cem\u003eCA Cancer J Clin\u003c/em\u003e. 2021;71(3):209-249. https://doi.org/10.3322/caac.21660\u003c/li\u003e\n\u003cli\u003eTekg\u0026uuml;l ZT, Divrik RT, Turan M, Konyalioglu E, Simsek E, G\u0026ouml;n\u0026uuml;ll\u0026uuml; M: İmpact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall. Urol J 2014; 11: 1248\u0026ndash;1252 https://doi.org/10.22037/uj.v11i1.1819\u003c/li\u003e\n\u003cli\u003eYorulmaz EM, Kose O, Ozcan S, Gorgel SN, Akin Y. Factors İnfluencing Bladder Perforation during Transurethral Resection of Bladder Cancer: A Comprehensive Analysis. \u003cem\u003eArchEspUrol\u003c/em\u003e.2024; 77(5): 471-478. https://doi.org/10.56434/j.arch.esp.urol.20247705.66\u003c/li\u003e\n\u003cli\u003eDivrik RT, Yildirim U, Zorlu F, Ozen H. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial. J Urol. 2006; 175: 1641-4. https://doi.org/10.1016/S0022-5347(05)01002-5\u003c/li\u003e\n\u003cli\u003eMatloubieh JE, Hanelin D, Agalliu I. Comparisons of Intravesical Treatments with Mitomycin C, Gemcitabine, and Docetaxel for Recurrence and Progression of Non-Muscle Invasive Bladder Cancer: Updated Systematic Review and Meta-Analysis. \u003cem\u003eCancers (Basel)\u003c/em\u003e. 2024; 16(24): 4125. https://doi.org/10.3390/cancers16244125\u003c/li\u003e\n\u003cli\u003eVolz Y, Trappmann R, Ebner B, et al. Absence of detrusor muscle in TUR-BT specimen - can we predict who is at highest risk?. \u003cem\u003eBMC Urol\u003c/em\u003e. 2023; 23(1): 106. https://doi.org/10.1186/s12894-023-01278-7\u003c/li\u003e\n\u003cli\u003eBalbay MD, Cimentepe E, Unsal A, Bayrak O, Ko\u0026ccedil; A, Akbulut Z: The actual incidence of blad-der perforation following transurethral bladder surgery. J Urol 2005; 174: 2260\u0026ndash;2262. https://doi.org/10.1097/01.ju.0000181811.61199.35\u003c/li\u003e\n\u003cli\u003ePanagoda PI, Vasdev N, Gowrie-Mohan S. Avoiding the Obturator Jerk during TURBT. \u003cem\u003eCurrUrol\u003c/em\u003e. 2018; 12(1): 1-5. https://doi.org/10.1159/000447223 \u003c/li\u003e\n\u003cli\u003eYanagisawa T, Kawada T, vonDeimling M, et al. Repeat Transurethral Resection for Non-muscle-invasive Bladder Cancer: An Updated Systematic Review and Meta-analysis in the Contemporary Era. \u003cem\u003eEur Urol Focus\u003c/em\u003e. 2024; 10(1): 41-56. https://doi.org/10.1016/j.euf.2023.07.002\u003c/li\u003e\n\u003cli\u003eNicoletti R, Gauhar V, Castellani D, Enikeev D, Herrmann TRW, Teoh JY. Current Techniques for En Bloc Transurethral Resection of Bladder Tumor: A Hands-on Guide Through the Energy Landscape. \u003cem\u003eEur Urol Focus\u003c/em\u003e. 2023; 9(4): 567-570. https://doi.org/10.1016/j.euf.2023.04.007\u003c/li\u003e\n\u003cli\u003eCulpan M, Kazan O, Acar HC, Iplikci A, Atis G, Yildirim A. The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors. \u003cem\u003eActas Urol Esp (Engl Ed)\u003c/em\u003e. 2022; 46(7): 423-430. https://doi.org/10.1016/j.acuroe.2022.05.001\u003c/li\u003e\n\u003cli\u003eAkitake M, Yamaguchi A, Shiota M, et al. Predictive Factors for Residual Cancer in Second Transurethral Resection for Non-muscle-invasive Bladder Cancer. \u003cem\u003eAnticancer Res\u003c/em\u003e. 2019; 39(8): 4325-4328 https://doi.org/ 10.21873/anticanres.13598\u003c/li\u003e\n\u003cli\u003eMiyake M, Nishimura N, Inoue T, et al. Fluorescent cystoscopy-assisted en bloc transurethral resection versus conventional transurethral resection in patients with nonmuscle invasive bladder cancer: study protocol of a prospective, open-label, randomized control trial (the FLEBER study). \u003cem\u003eTrials\u003c/em\u003e. 2021; 22(1): 136. https://doi.org/10.1186/s13063-021-05094-y\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bladder cancer recurrence, Bladder cancer progression, Obturator nerve block, General anaesthesia","lastPublishedDoi":"10.21203/rs.3.rs-6737965/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6737965/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003ePurpose\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe aim of our study was to evaluate and compare the effects of the type of anaesthesia applied during surgery on tumor recurrence and progression in patients with bladder tumors located in the lateral bladder wall\u003c/p\u003e \u003cp\u003e \u003cb\u003eMaterials and Methods\u003c/b\u003e:\u003c/p\u003e \u003cp\u003ePatients who underwent primary transurethral resection of a bladder tumor (TUR-BT) due to lateral wall bladder tumors between 2015 and 2020 were retrospectively evaluated. Patients who received spinal anaesthesia with an obturator nerve block (Group 1) and those who received general anaesthesia with a curare (Group 2) were included. After patients with incomplete data, irregular follow-up, recurrent tumors, muscle-invasive pathology, or incomplete resections were excluded, a total of 168 patients with primary lateral wall bladder tumors were included in the final analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eGroup 1 included 102, patients, and Group 2 included 66 patients. The mean follow-up was 67.5 months (range: 60\u0026ndash;105) in Group 1 and 69 months (range: 60\u0026ndash;107) in Group 2. The five-year recurrence rate was 40%, %18 Group 1 and Group 2. At the same time, the average time to recurrence was 21 months in Group 1 and 31 months in Group 2. Patients in group 2 were found to have less and later bladder tumor recurrence.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eAlthough the use of general anaesthesia alone does not seem to influence the long-term recurrence rates of lateral wall bladder tumours, it may have an effect on the time to recurrence and disease progression.\u003c/p\u003e","manuscriptTitle":"How safe are bladder lateral wall tumors?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 10:39:39","doi":"10.21203/rs.3.rs-6737965/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66d447fc-eddb-4ef8-b658-80baed59e355","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T13:53:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 10:39:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6737965","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6737965","identity":"rs-6737965","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}