Retraction Note: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

The Editor-in-Chief has retracted this article [1] because it shows significant overlap with a previously published article by Pladzyk et al. [2].

Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

AIM: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia. METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB. RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032). CONCLUSION: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

Treatment of iatrogenic ureteral injuries during various operations for malignant conditions.

In the present study we report twenty-nine patients with iatrogenic injuries and management during various operations for malignant conditions. The patients were reviewed in order to identify and study the incidence, type of treatment administered and outcome. The study group was composed of 29 patients with 31 iatrogenic injuries between 1992 and 1999. General surgical, gynecological and urological procedures accounted for 24 (83%), 4 (14%), and 1 (3%) injuries respectively. Twenty-eight injuries were diagnosed at operation and three after an interval of 5, 17 and 45 days. Of the injuries, 51% occurred in the lower third of the ureter, 30% in the upper third and 19% in the middle third. Complete transsection, excision, ligation and partial transection accounted for 19 (61%), 9 (29%), 2 (7%), and 1 (3%) respectively. Treatment consisted of end-to-end ureteroureteral anastomosis in 18 cases; ileal interposition in 4 cases; transureteroureterostomy and ureteroneocystostomy in 2 cases; surgical repair, nephrectomy, ureterocutaneostomy and ileal loop in each of the remaining cases. Primary healing was obtained in all patients. General surgical procedures are the most common cause of iatrogenic injuries during malignant conditions. The proper identification and, when necessary, identification of the ureter at the pelvic brim, should decrease the incidence of iatrogenic ureteral injury. When identified at injury and treated immediately such injuries seldom lead to loss of renal function. We do not advocate to perform nephrectomy for any type of ureteric injury since the preservation of the kidney should be the aim of a surgeon.

Extragonadal germ cell tumors: clinicopathologic findings, staging and treatment experience in 14 patients.

Extragonadal germ cell tumors (EGCT) are a rare group of neoplasms histologically identical to testicular counterparts. Fourteen cases of primary mediastinal and retroperitoneal germ cell tumors were treated with chemotherapy and radiotherapy between 1987 and 1999 in Ankara Oncology Hospital. There were 9 (64%) complete remissions (CR),one (7%) partial remission (PR) and 2 (14%) stable diseases (SD). The remaining 2 patients were lost due to dissemination of disease. The median duration of response was 19 months. Our modified chemotherapeutic results were similar to original doses of PVB and BEP but toxicity was less. The neccesity of a uniform staging system and treatment programs are discussed.

Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia.

OBJECTIVE: To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHODS: The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of < 15 mL/s. Pre-operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post-void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre-operatively and again 24 h after the operation. Patients were divided randomly into two groups: the first underwent a conventional TURP and the second TUEP using 240-300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups. RESULTS: The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform. CONCLUSION: Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources: further studies with more patients and a longer follow-up are required to determine the efficacy and safety of this procedure.