Outcome of transurethral resection of bladder tumour under spinal anaesthesia combined with obturator nerve block in Sri Lanka.

PURPOSE: Transurethral resection of bladder tumour (TURBT) is done under general anaesthesia (GA) with muscle relaxation to prevent obturator jerk and bladder perforation. TURBT under spinal anaesthesia (SA) with obturator nerve block (ONB) may prevent the obturator jerk while eliminating the disadvantages of GA. OBJECTIVES: To assess the outcome of TURBT under SA and ONB. METHODS: Patients undergoing TURBT for lateral wall tumours from 01.11.2017 to 30.10.2020 were prospectively studied. Anterior branch of obturator nerve with plain Bupivacaine was blocked with the guidance of an ultrasound scan and a nerve stimulator. Significant obturator jerk which necessitated conversion to GA was defined as failed ONB. RESULTS: Out of 72 patients with mean age of 66.7 years underwent ONB, 61 (84.7%) were men. Fifty two (72.2%) had unilateral and 20 (27.8%) had bilateral blocks. Sixty one (84.7%) patients had no obturator jerk whereas 5 (7%) had a mild jerk which did not preclude safe resection. Six patients (8.3%) had a failed ONB requiring conversion to GA. None had a bladder perforation requiring laparotomy, developed neurovascular injury or anaesthetic toxicity and only one patient required intensive care monitoring. CONCLUSION: SA with anterior branch of ONB is an effective and safe alternative to GA with muscle relaxation for TURBT although a randomized trial is necessary to determine the true efficacy and safety over the other.

Diagnostic yield and outcome of transrectal ultrasound-guided prostate biopsy in Sri Lanka.

Abstract: The study was aimed to determine the diagnostic yield and outcome of transrectal ultrasound-guided prostate biopsy (TRUSPB) in a cohort of Sri Lankan men. A prospective study was conducted among 333 (median age: 70 years, range:48-88) men from a single urology unit. All patients underwent TRUSPB for persistently elevated serum prostate specific antigen (PSA)≥4.00 ng/mL or suspicious rectal examination. The prostate cancer (PCa) detection rate was 57.7%. The PCa detection rate for PSA levels of 4.00 to <10, 10.00 to <20, 20.00 to <40, 40.00 to <100 and ≥100.00 ng/mL were 15/43(34.9%), 23/88(26.1%), 41/72(56.9%), 51/63(81.0%) and 60/62(96.8%) respectively. Ten patients required further biopsies for rising PSA despite a first benign biopsy and three had PCa. Mild complications were identified in 6.9%(n=23). The high PCa detection rate probably reflects the difference in our policy to perform biopsies only when serum PSA level is persistently elevated. TRUSPB appears to have a satisfactory yield with acceptable level of complications in the Sri Lankan resource limited setting.

Clinicopathological characteristics and oncological outcomes of patients with renal cell carcinoma.

ABSTRACT: Although certain characteristics of renal cell carcinoma (RCC) seen in Sri lanka are different to the developed world and incidence is rising, no data on oncological outcome and patient survival are avaialble. A hospital-based cohort study was done in a tertiary referral centre over a period of eight years (2012-2019). A total of 285 newly diagnosed RCC had a mean follow-up period of 28.3 months. Radical nephrectomy was performed in 189 patients while 91 patients had partial nephrectomy. Clear cell RCC which was seen in 231 (81.1%) patients while papillary RCC was seen in 43 (15.1%). There were 54 deaths during the follow-up. The 30-day postoperative mortality was 2.1%. Thirty (10.5%) patients developed metastases while three patients developed local recurrences. The overall five -year survival rate was 72.8% (95%CI=65.9-80.5). Five-year survival of papillary RCC (60.5%) was lower than clear cell RCC (74.1%). Tumour stage, presence of metastases and histological grade of the tumour influenced the survival. Gender (p= 0.3), histological type (p= 0.5) or type of surgery (p=0.2) had no statistically significant effect on survival.