The Use of Lumbar Sympathetic Blockade at L4 for Management of Malignancy-Related Bladder Spasms

Background: Cancer-related bladder spasms may be a rare but severe symptom ofbladder or metastatic cancer or its related treatments. Various treatments describedin the literature include systemic medications, intravesical or epidural medications, oreven sacral neurolectomies.Objective: We present 3 patients who have suffered from bladder spasmeither from invasion of the bladder wall by tumor (2 patients) or from intravesicalchemotherapeutic treatment.Design: Case Report.Setting: Cancer pain management hospital.Methods: For each patient, we describe the use of lumbar sympathetic block tosuccessfully treat the bladder spasms. Sympathetic blockade was performed at theleft anterolateral border of lumbar vertebra L4. We used 10 mL of local anesthetic(0.25% bupivacaine) delivered in 2 mL aliquots, each given after negative aspirationfor heme. Each procedure was performed with fluoroscopic guidance (both AP andlateral views) with the use of iodine contrast (Omnipaque-180) to confirm the locationof the medication and its resulting spread.Results: All 3 patients had a reduction in the frequency and intensity of spasms,with 2 out of 3 patients not having a recurrence of the spasms for up to 2 monthspost procedure and follow up.Limitations: Case Report.Conclusion: Lumbar sympathetic blockade could be a useful treatment for recurrentbladder spasm in the oncologic population. Based on these findings, we feel that thebranches of the sympathetic nerve set at L4 may be a good target for neurolyticprocedures, such as radiofrequency ablation, for long term treatment of bladderspasms. Further research is necessary to determine the efficacy of this technique forthe treatment of bladder spasms in the oncologic population.Key words: Bladder spasm, cancer pain, splanchnic nerve, lumbar sympatheticblock