Background/Objectives: Transurethral resection of bladder tumors (TURBT) is the standard for diagnosing and treating non-muscle-invasive bladder cancer. For lateral bladder wall tumors, obturator nerve stimulation can trigger sudden adductor contractions, raising the risk of perforation, hemorrhage, incomplete resection, and poor specimen quality. We evaluated the impact of obturator nerve block (ONB) on specimen quality and perioperative complications. Methods: In this single-center retrospective study, patients with lateral wall tumors treated by TURBT between October 2022 and December 2024 were divided into an ONB group (spinal anesthesia plus ONB) and a non-ONB group (spinal anesthesia alone). Specimen quality, perioperative complications, and 12-month recurrence were analyzed. Results: In this retrospective cohort of 219 patients (135 ONB, 84 non-ONB), high-quality specimens were more frequent with ONB (71.1% vs. 35.7%, p < 0.001). No perforations occurred with ONB versus 5 (6.0%) without (p = 0.008); hematuria (11.1% vs. 28.6%, p = 0.002) and 12-month recurrence (4.4% vs. 16.7%, p = 0.005) were also lower. Conclusions: ONB added to spinal anesthesia during TURBT for lateral wall tumors was associated with improved specimen quality and fewer perioperative complications. The lower recurrence rate should be considered hypothesis-generating, given the retrospective design and the small number of recurrence events; prospective studies are needed.

Background/Objectives: Non-muscle-invasive bladder cancer (NMIBC) recurs frequently, and clinicopathological tools predict recurrence imperfectly. We assessed whether six preoperative blood-count-derived inflammatory indices (SII, SIRI, PIV, NLR, PLR, and LMR) are associated with adverse histology and 12-month recurrence and whether SIRI adds prognostic information to established risk factors. Methods: We retrospectively analysed 180 consecutive NMIBC patients treated by transurethral resection of bladder tumour (TURBT) and immediate instillation. Indices were modelled per 1-SD in logistic (adverse histology: high grade, T1 or carcinoma in situ) and Cox (recurrence) models adjusted for established risk factors. Results: Adverse histology occurred in 121 patients (67.2%); 88 recurred (12-month Kaplan–Meier estimate: 49.2%). All six indices were univariably associated with both endpoints, with similar effects (SIRI: adverse histology OR: 2.35, 95% CI: 1.41–3.90; recurrence HR: 1.41, 1.19–1.67). After adjustment, SIRI was not independently associated with adverse histology (OR: 1.69, 0.92–3.11) or recurrence (HR: 1.10, 0.86–1.40) and did not improve discrimination (ΔC: 0.001, −0.006 to 0.016). Results were robust across sensitivity analyses, including propensity weighting for BCG (limited by positivity violations). Conclusions: SIRI added no demonstrable independent prognostic value. Given modest overfitting (optimism-corrected calibration slope: 0.79), neither the indices nor the model should be used clinically without external validation and recalibration.

Background/Objectives: Transurethral resection of bladder tumors (TURBT) is the standard for diagnosing and treating non-muscle-invasive bladder cancer. For lateral bladder wall tumors, obturator nerve stimulation can trigger sudden adductor contractions, raising the risk of perforation, hemorrhage, incomplete resection, and poor specimen quality. We evaluated the impact of obturator nerve block (ONB) on specimen quality and perioperative complications. Methods: In this single-center retrospective study, patients with lateral wall tumors treated by TURBT between October 2022 and December 2024 were divided into an ONB group (spinal anesthesia plus ONB) and a non-ONB group (spinal anesthesia alone). Specimen quality, perioperative complications, and 12-month recurrence were analyzed. Results: Of 219 patients (135 ONB, 84 non-ONB), high-quality specimens were more frequent with ONB (71.1% vs. 35.7%, p < 0.001). No perforations occurred with ONB versus 5 (6.0%) without (p = 0.008); hematuria (11.1% vs. 28.6%, p = 0.002) and 12-month recurrence (4.4% vs. 16.7%, p = 0.005) were also lower. Conclusions: ONB added to spinal anesthesia during TURBT for lateral wall tumors was associated with improved specimen quality and fewer perioperative complications. The lower recurrence rate should be considered hypothesis-generating, given the retrospective design and lack of multivariate adjustment; prospective studies are needed.

Small-bowel tumors are a heterogeneous and relatively uncommon group of neoplasms whose definitive diagnosis frequently cannot be established before surgery. Their common jejunal or ileal location limits conventional endoscopic access, and stenosing, predominantly extraluminal, or complicated presentations may render preoperative biopsy impossible. In such situations, the surgeon may have to decide the extent of resection and the need for lymphadenectomy without a histological diagnosis, even though the optimal strategy differs substantially among adenocarcinoma, gastrointestinal stromal tumor (GIST), small-bowel neuroendocrine tumor (SBNET), lymphoma, and desmoid-type fibromatosis. This narrative review integrates clinical presentation, preoperative computed tomography (CT) features, and intraoperative macroscopic findings to support a presumptive diagnosis and guide surgical decision-making when histology is unavailable. The evidence was synthesized along the decision pathway preoperative imaging → diagnostic suspicion → intraoperative appearance → surgical decision → definitive histopathology. Histology-specific CT associations are relatively well documented, whereas the independent ability of intraoperative macroscopic impression to predict histology remains limited. We propose a pragmatic, histology-oriented decision framework that prioritizes clinical urgency, disease extent and resectability, the feasibility of preoperative tissue sampling, and the potential impact of histology on the surgical procedure. The framework is conceptual and requires prospective validation; its aim is not to replace histopathological examination but to reduce the risk of both oncologically inadequate and unnecessarily extensive resections.