Editing Transurethral Resection of Bladder Tumour (section)

== Obturator nerve reflex ==

* '''<span style="color:#ff0000">If lesion on lateral wall, there is risk of an obturator reflex whereby the cautery current stimulates the obturator nerve, causing the ipsilateral leg to aDDuct</span>'''
** '''<span style="color:#ff0000">This can lead to inadvertent deflection of the instrument laterally and can cause perforation.</span>'''
* '''<span style="color:#ff0000">Techniques to reduce the risk of an obturator reflex (5)</span>:'''
*# '''<span style="color:#ff0000">Minimize distention of the bladder</span>'''
*#* Continuous irrigation with the bladder filled only enough to visualize its contents minimizes bladder wall movement and lessens thinning of the detrusor through overdistention, which should reduce the risk of perforation
*# '''<span style="color:#ff0000">Use bipolar over monopolar cautery</span>'''
*# '''<span style="color:#ff0000">If the patient is under a general anesthetic, administer a general muscle relaxant</span>'''
*# '''<span style="color:#ff0000">Direct injection of local anesthetic (20-30 mL lidocaine) into the obturator nerve and its canal</span>'''
*# '''<span style="color:#ff0000">Tapping the pedal during resection</span>'''