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Homepage – Forum Forums Non-Muscle Invasive Bladder Cancer Obturator Reflex. It can happen to you.

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  • #44392
    Brown
    Participant

    I just learned about obturator reflex from the Dr. in Toronto.

    This is what happened to me in my 3rd TURBT surgery on January 3 (see link below).  There was a deep cut (almost perforation) to the bladder wall.  It’s fairly common during TURBT and it can usually be prevented, but my initial Dr. didn’t bother to do anything to prevent it nor did he explain it at all to me other than to say “your leg moved”.  Zero explanation.  Zero options.  Nothing.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198773/

    If I do have to have another TURBT I’ll go to the Dr.  in Toronto for the procedure.  Much, much safer.  And he said that there are things available to do to prevent the obturator reflex (leg jerk) especially now that we know I’m susceptible to it. And he would use blue light as part of the Turbt procedure.

    Thought you’d be interested in all this 😊 I have to wonder if my initial Dr. did something to damage my obturator nerve and that has something to do with all the hip/leg/back pain I have.  Plus there have been studies done that show that BCG treatments can trigger arthritis in the knee!  I also wonder if BCG can trigger arthritis in the hip. There is so much we don’t know.  My severe hip issues really started to get a lot worse following my BCG treatments in October/November.  Interesting. I’m booked now for a full hip replacement on November 9.  One thing leads to another.

    In any event I hadn’t heard of this obturator reflex before but it meant that I couldn’t have the chemo wash during the TURBT on January 3 and that I had to wear a catheter for a full week.  There was no explanation other than “You moved your leg”… as if it was my fault.  When I asked why I had to wear a catheter for a week, all he said was “We don’t do this for fun”.  Zero explanation other than that. Very dismissive. Unbelievable really.

    I am so grateful for the connection to the Dr. in Toronto. Night and day difference.

    Thank you again for that referral.

    #44394
    Nightingale
    Keymaster

    Hi Brown,

    Thank you for your post.  This is very interesting indeed.  I hope the other patients read this and can talk with their Urologist about it, just to ensure precautionary measures are taken by their urologist during the Turbt procedure.

    My best,

    #44397
    coliver52
    Participant

    Thank you Brown for sharing this information with us. I had certainly never heard of obturator reflex, and I am sorry that you have been the victim of incompetence by your previous doctor. Looking online, it is clear there are nerve blocks that surgeons can use during TURBTs to reduce the risk of this. I am so glad you have now found a really good doctor.

    I usually look on Google Scholar for scientific articles relating to bladder cancer but lots of articles on Google Scholar only present a study’s abstract and deny access to the whole article. Being a prof, I’m lucky enough to have access to full articles and did a search using the terms “arthritis” and “obturator reflex” but nothing came up linking the two problems together. Maybe it is just because no research has been done yet in this area.

    You were wondering also about your arthritis and BCG and it can definitely cause knee arthritis as you say  Though the causal link between BCG installations and arthritis has been noted since the 1970s, this link has only recently been studied systematically, rather than on a case by case basis (“Reactive Arthritis Following Bacillus Calmette-Guerin Therapy for Bladder Cancer: A Systematic Literature Review” in Current Rheumatology Reports 2021, p.23-29.) The authors conclude it’s a rare but serious side effect and they found that some joints are more likely to be affected than others. In their study, in descending order, the most affected joints were knees, ankles, wrists, elbows, shoulders, hands, and fingers. Just because the hip joint wasn’t included in the list doesn’t mean it’s impossble BCG had an effect. I wish you all the best going forward with a better doctor.

    #44402
    Joe
    Participant

    I recall that the first time I had TURBT about 5 years ago.  I chose spinal anesthesia because I have chronic asthma and my lung condition is not that good.   Just as the urologist started something, I felt legs twitched. Then I heard the urologist speaking to the attending anesthesiologist that he could not do as I was moving.  I do not remember what the anesthesiologist did but the TURBT continued.  I did not know anything about bladder wall perforation at that time.  I do not remember if I was release on the same day or the next day, but I was released with a catheter attached.   I chose general  anesthesia for the following TURBT and TURP.   I wonder if general anesthesia will reduce obturator reflex (jerk, twitch).

    I have found a paper “Avoiding the Obturator Jerk during TURBT” published by UK authors in 2018.   The paper lists various approaches. Choosing general anesthesia over spinal  anesthesia is one of them.  The paper describes the anatomy of the obturator nerve, then explains different approaches.

    “www.ncbi.nlm.nih.gov/pmc/articles/PMC6198773/”

    best

    p.s. I have noticed the link is the same paper which Brown listed originally.

    • This reply was modified 1 year ago by Joe.
    • This reply was modified 1 year ago by Joe.
    • This reply was modified 1 year ago by Joe.
    #44424
    marysue
    Participant

    Hi Brown:

    I’m sorry that you have been through all that.  I too, would have sought out another doctor if I had one respond like that.  Doctors owe patients full disclosure and explanations for what the diagnosis is, treatment options and if anything unusual happens during, post surgery or treatments. We also have the right to ask questions in order to gain an understanding of our situation and no doctor should belittle a patient for asking questions.

    I have had 3 TURBTS, the last one was in October 2022.  This time at my doctor’s recommendation, I did have Epirubicin put in my bladder post TURBT which created its own set of misadventures.  The other thing that I remember but have not asked my doctor about is that I felt really numb in the perinium post op.  I don’t know for sure but I’m wondering if I was given a nerve block during surgery.  I’m thinking this may have contributed to my not being able to pee post op after the catheter was removed. But at least I didn’t move.  I know that I was in stirrups which I would think make it very difficult for a patient to move during surgery. I did have a general for all 3 TURBTs.

    I too, have heard that BCG treatments can cause a version of arthritis.  I had severe muscle and joint pain during my treatment sessions in 2011-12.  The recent treatment sessions only caused minor discomfort but it was a different type of BCG.  Whether that had anything to do with it, I’m not sure.

    As for the reason for needing a catheter for a week post op – it can vary.  My first 2 TURBTS were fine and I could pee post op no issue but my 3rd TURBT was a more extensive surgery and as mentioned included having the Epirubicin post op and  since I couldn’t pee post op, it was necessary to reinsert the catheter.  Once I was stable, I was given the order to go home with it for 5 days. I ended up needing it for a second week because I developed a post op infection. I went to the ER at the hospital where I had the surgery and a nurse put in another catheter. Some doctors just have a patient have it in as part of their protocol.  Others have a patient keep it in if they are passing a lot of clots, mucus etc. post op because that debris will make it very difficult to urinate.  Been there, done that with this 3rd TURBT.  I never thought I’d ever beg for a catheter but when you can’t pee, the pain is agonizing.

    AS for your hip/back/leg pains BCG may or may not have been a factor.  Being in stirrups for surgery can aggravate anyone’s hip/back/leg issues.  Before my recent TURBT the nurse who called to do a preop Q&A asked me about any pain in those areas.  I told her that I have sciatica in my left leg/hip and often have lower back pain.  She told me that she would make sure that info was noted in my file as it would affect how I was to be positioned for the surgery. Post cysto, post TURBT, and post BCG I always get a tingling sensation in my left groin area so they must ding some type of nerve when they go in the bladder.

    So if you need another TURBT at some point especially if it is after your hip surgery, I strongly recommend that you make sure that surgical staff know that you have an artificial hip.  They are supposed to ask but I think when they are busy they forget.  It will also be important to let them know for any future cystos as well.

    Thanks for sharing your experience.  This is very valuable information.  Best of luck with the new doctor and going forward.  Hopefully this is you last TURBT.  (((HUGS)))

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