Effect of Pudendal Nerve Block on the Prevention of Postoperative Bladder Spasm and Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Holmium Laser Enucleation of the Prostate

Abstract

Purpose Bladder spasm (BS) and catheter-related bladder discomfort (CRBD) are complications after transurethral holmium laser enucleation of the prostate (HoLEP). The pudendal nerve (PN) innervates the perineum. Therefore, we evaluated whether PN block (PNB) can reduce the incidence of BS and CRBD in patients undergoing HoLEP. Methods In this randomized, parallel, single-blind prospective study, we enrolled 110 patients who were scheduled to undergo HoLEP under general anesthesia. Patients were randomly allocated to the PNB group (ultrasound-guided PNB at the entrance of the pudendal [Alcock’s] canal bilaterally; n = 55) or the control group (general anesthesia only; n = 55). The primary outcome was the incidence of BS and CRBD at 0.5, 1, 2, 4, 6, 12, and 24 hours postoperatively. The CRBD severity, postoperative pain, and analgesic drug use were also assessed. A P value of < 0.05 was considered statistically significant. Results A significantly lower incidence of BS (P = 0.023) and CRBD (P < 0.001) was reported within the first 24 hours postoperatively in the PNB group. The incidence of CRBD above a moderate grade at 0.5 (P < 0.001), 1 (P < 0.001), 2 (P < 0.001), and 4 (P = 0.019) hours postoperatively was significantly lower in the PNB group. Additionally, postoperative pain scores and analgesic drug use were significantly lower in the PNB group. No PNB-related complications were observed. Conclusion PNB at the entrance of the pudendal canal bilaterally resulted in a lower incidence of BS and CRBD, less postoperative pain, and less analgesic drug use in patients undergoing HoLEP without PNB-related side effects. Implication Statement Bladder spasm and catheter-related bladder discomfort can occur in older individuals undergoing transurethral holmium laser enucleation of the prostate. They often result in severe pain and prolonging the hospital stay. We performed a bilateral ultrasound-guided pudendal nerve block at the entrance of the pudendal (Alcock’s) canal and found that the block reduced bladder spasm, catheter-related bladder discomfort, postoperative pain, and use of anesthetics. Besides, pudendal nerve block also decreased the severity of catheter-related bladder discomfort and helped older individuals achieve rapid recovery.

Comparison between the Efficacy of Sacral Erector Spina Plane Block and Pudendal Block on Catheter-Related Bladder Discomfort: A Prospective Randomized Study

“…Li Xiaoqiang et al [ 15 ] performed PNB to reduce CRBD in TURP cases and compared it with the control group and found that the incidence of CRBD was 52% to 64% in the pudendal group and 69% to 90% in the control group and was statistically significant at all times. Wang SY [ 16 ] found that VAS scores, incidence, and severity of CRBD decreased with PNB use in Holep surgery. The incidence was found to be 3.6–36.4% in the PNB group and 38.2–76.4% in the control group.…”

“…Data from a similar study by Wang SY et al [ 16 ] investigating the difference in the incidence of CRBD between transholium laser therapy pudendal block and control groups were used to determine the sample size. The minimum number of patients to be included in this study was calculated as 24 in each group using G*Power software (latest ver.…”

“…TAP block, dorsal penile block, and pudendal block were used as peripheral nerve blocks to reduce CRBD. The highest success and longest duration of effect were achieved with pudendal block [ 12 , 13 , 14 , 15 , 16 ].…”

“…Anatomically, afferent nerves to the urethra and bladder triangle originate from the sacral somatic nerves S2–4, and theoretically, these nerves should be blocked to reduce CRBD. Studies have been performed using ultrasound-guided pudendal nerve block to reduce CRBD in TURP surgery, and its use has shown success [ 14 , 15 , 16 ]. Furthermore, studies have shown that pudendal block is effective for postoperative analgesia in genitourinary surgery [ 18 , 19 ].…”