The Effect of Pudendal Blocks on Voiding Dysfunction Following Slings (PUBS)

To determine the effect of a bilateral pudendal block on voiding dysfunction following midurethral slings.

Midurethral slings (MUS) are commonly performed to treat stress urinary incontinence in women. One common complication is short-term postoperative voiding dysfunction. Approximately 20% of patients undergoing MUS have difficulty voiding in the immediate postoperative period and are discharged home with an indwelling bladder catheter. A pudendal block provides analgesia to the vulva, vagina, and perineum and is used in various fields, ranging from obstetrical indications to hemorrhoidectomies. The colorectal literature has demonstrated an improvement in postoperative voiding dysfunction with intraoperative bilateral pudendal blockade, presumably due to pain relief. However, only one study has explored the effect of a pudendal blockade on postoperative voiding in patients undergoing MUS. This was a small French case series of 9 patients, and it concluded that it was a safe procedure with good patient satisfaction. Given the scant literature evaluating voiding dysfunction following pudendal blocks in MUS, and the encouraging data from anorectal surgeries, we aim to study this effect via a randomized, placebo-controlled, double-blinded trial.

Inclusion Criteria: Women undergoing a midurethral sling without concomitant procedures under general anesthesia Exclusion Criteria: Unable to consent (lacking capacity) Under 18 years of age Pregnant women Prisoners Using intermittent self-catheterization preoperatively Neurological disease or spinal cord injury resulting in voiding dysfunction Allergy to bupivacaine Diagnosis of chronic pain syndromes Daily use of narcotics Intra-operative bladder injury necessitating use of a prolonged indwelling Foley catheter

Individual participant data that underlie the results reported in the article after de-identification.

Investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose.

Maheshwari D, Sierra T, Leung K, Hall C, Flynn M. Effect of Pudendal Blockade on Bladder Emptying After Midurethral Sling: A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):e465-e468. doi: 10.1097/SPV.0000000000000963.