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Voiding Function After Midurethral Slings With and Without Local Anesthetic: Randomized Controlled Trial.

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Bupivacaine did not impact voiding function after retropubic midurethral sling surgery but reduced postoperative pain. Preoperative phenazopyridine may help prevent urinary retention.

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Area of Science:

  • Urology
  • Anesthesiology
  • Gynecology

Background:

  • Postoperative voiding dysfunction and pain are common complications following retropubic midurethral sling procedures.
  • Periurethral hydrodissection is utilized to improve surgical outcomes.

Purpose of the Study:

  • To compare the effects of periurethral bupivacaine versus normal saline on postoperative voiding function and pain.
  • To evaluate the impact of periurethral hydrodissection on outcomes after retropubic midurethral sling surgery.

Main Methods:

  • A randomized double-blind placebo-controlled study involving 90 patients undergoing retropubic midurethral sling.
  • Patients received either periurethral bupivacaine with epinephrine or normal saline with epinephrine.
  • Postoperative pain assessed via visual analog scale; voiding function determined by voiding trials.

Main Results:

  • No significant difference in voiding dysfunction between bupivacaine and saline groups (17.9% vs. 24.4%, P = 0.481).
  • Bupivacaine group reported significantly lower pain scores at 6–7 hours postoperatively (P = 0.028).
  • Preoperative phenazopyridine was associated with a lower failure rate in voiding trials (8% vs. 30%, P = 0.010).

Conclusions:

  • Periurethral bupivacaine does not affect postoperative voiding function but alleviates pain at 6–7 hours.
  • Preoperative phenazopyridine may be beneficial in reducing postoperative urinary retention.
  • Further research is warranted to confirm the role of phenazopyridine in preventing urinary retention.