title: Bladder injury secondary to obturator reflex is more common with plasmakinetic transurethral resection than monopolar transurethral resection of bladder cancer.
abstract: BACKGROUND
  Transurethral resection (TUR) is the most common surgical technique for the diagnosis and initial treatment of bladder cancer. In this study, we evaluated two surgical techniques in terms of bladder injury due to obturator reflex in patients that underwent TUR for non-muscle invasive bladder cancer (NMIBC).
  
  
  METHODS
  93 patients who underwent TUR for bladder cancer were analyzed. Fifty patients underwent monopolar resection and 43 patients underwent plasmakinetic resection. Standard TUR were performed with conventional Storz monopolar resection using a U-shaped cutting loop, 120V cutting/80 V coagulation settings, 5% mannitol fluid was used for irrigation. For bipolar resection, an Olympus ESG-400 plasmakinetic loop bipolar device using a U-shaped cutting loop, 160V cutting/80V coagulation settings and normal saline for irrigation was used.
  
  
  RESULTS
  In the monopolar resection group; obturator reflex was seen in 4 (8%) patients. Bladder perforation caused by the obturator reflex was seen in 4 (8%) patients, but hemorrhage and other major complications were not seen in this group. In the bipolar resection group; obturator reflex was seen in 15 (34%) patients. Bladder perforation caused by the obturator reflex was seen in 10 (23%) patients.
  
  
  CONCLUSIONS
  Bipolar transurethral resection of bladder tumor was not superior to monopolar resection with respect to obturator reflex and bladder perforation. We conclude that we do not yet have enough experience concerning the long-term complications and major complications associated with bipolar resection of bladder cancer.
authors.affiliation: Izmir Katip Celebi University Atatürk Training and Research Hospital, Urology Department, Izmir, Turkey.
authors.forename: Kutan
authors.initials: K
authors.lastname: Ozer
authors.affiliation: Izmir Katip Celebi University Atatürk Training and Research Hospital, Urology Department, Izmir, Turkey.
authors.forename: Mustafa Ozan
authors.initials: MO
authors.lastname: Horsanali
authors.affiliation: Izmir Katip Celebi University Atatürk Training and Research Hospital, Urology Department, Izmir, Turkey.
authors.forename: Sacit Nuri
authors.initials: SN
authors.lastname: Gorgel
authors.affiliation: Izmir Katip Celebi University Atatürk Training and Research Hospital, Urology Department, Izmir, Turkey.
authors.forename: Emin
authors.initials: E
authors.lastname: Ozbek
keywords: bladder injury; monopolar; obturator reflex; plasmakinetic; transurethral resection