The effect of spinal anaesthesia on urethral function

Abstract

This study was to assess the effect of spinal anaesthesia on urethral retro-resistance pressure (URP), cough pressures and tendency to leak. The population consisted of 32 women undergoing a tension-free vaginal tape (TVT) operation under a spinal anaesthetic. URP, cough pressures and an assessment of the degree of leak were performed before the spinal anaesthetic was placed. A standard anaesthetic technique was used, and measurements were repeated after the spinal anaesthetic was inserted. The degree of leak was assessed on a five-point scale with 350 ml in the bladder. The cough pressures and URP values were averaged over three or more measurements. The mean URP value fell from 75.0 to 54.0 cm/H2O (p = 0.0003) after the spinal was inserted. There was a non-significant fall in mean cough pressure from 85.0 to 67.5 cm/H2O (p = 0.06). The degree of leakage increased (p = 0.005). Spinal anaesthesia causes a fall in the resistance in the urethra but does not cause a significant fall in the pressure generated by a cough. Women are more likely to leak after coughing during the TVT operation under spinal anaesthesia than they are before the spinal is inserted. The cough test under spinal anaesthesia does not mimic the result of coughing without a spinal.

Dexmedetomidine: an alternative for epidural anesthesia in tension-free vaginal-tape surgery

“…But this is not well tolerated by the patients, who require sedation or general anesthesia. In another study, the effect of spinal anesthesia on urethral function and cough pressure was evaluated; coughing under spinal anesthesia may not be as efficient as coughing without a spinal, and this resulted in cough-stress test being unable to reproduce preanesthetic conditions in women with a spinal anesthesia [19]. Similar to spinal anesthesia, epidural anesthesia can also cause weakness in cough pressures; however in our study, we saw no difference between the dexmedetomidine and epidural anesthesia groups.…”

Randomized controlled trial of cough test versus no cough test in the tension-free vaginal tape procedure: effect upon voiding dysfunction and 12-month efficacy

“…Adamiak et al found that the mean intra-abdominal cough pressure generated during spinal anesthesia was significantly lower than that of the women who coughed under LA [12]. In contrast, Duckett et al demonstrated that women were more likely to leak when coughing under spinal anesthesia than when awake preoperatively due to a fall in urethral resistance associated with spinal anesthesia [13]. As such, the anesthetic technique appears to strongly influence the use of the intraoperative cough test during the TVT.…”

The effect of local anaesthetic infiltration on urethral function during the tension-free vaginal tape (TVT) procedure

“…When a cough test is used, more tension will need to be applied under spinal anaesthesia to achieve the same degree of leakage when compared to exactly the same technique with a local anaesthetic technique. However, different filling volumes were used to assess urethral function in this study compared to the previous work under spinal anaesthesia [7]. This might also have an effect on the URP results, although this should not alter the overall findings, as the patients acted as their own controls in both studies.…”

“…The operation can also be performed under regional anaesthesia [4,5]. Previous work assessing the effect of spinal anaesthesia on urethral function has demonstrated that cough pressures are not significantly reduced, but urethral relaxation causes an increased tendency to leak after the spinal anaesthetic [6,7]. Spinal anaesthesia alters the bladder neck position and urethral closure function, shortening the anatomical and functional urethral length and reducing the maximum urethral closure pressure and pressure transmission ratio in the urethra [6].…”