The Effect of Pudendal Blocks on Voiding Dysfunction Following 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