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

Catheter-Related Bladder Discomfort: Insights Into Pathophysiology, Clinical Impact, and Management

Catheter-related bladder discomfort (CRBD) is a frequent postoperative complication that significantly impacts the quality of recovery in patients undergoing transurethral surgeries. It manifests as suprapubic pain, an intense urge to void, and bladder spasms due to muscarinic receptor activation. This narrative review provides a comprehensive analysis of CRBD, with a particular focus on bladder spasms in patients treated with transurethral resection of bladder tumors (TURBT) or the prostate (TURP). The review explores the underlying pathophysiology, clinical implications, and evidence-based management strategies, including pharmacological interventions such as antimuscarinics and nerve blocks, as well as non-pharmacological measures.

The Development of Publications on Catheter-Related Bladder Discomfort: A Bibliometric Analysis

Background

Catheter-related bladder discomfort (CRBD) is a risk factor that impacts postoperative recovery and still troubles patients and healthcare staff. The present study is a bibliometric analysis of CRBD.

Methods

The publications on CRBD were retrieved from the Web of Science Core Collection. VOSviewer and Excel were applied to present the current status and hot spots of CRBD research. We analyzed parameters such as the annual number of publications, countries/regions, organizations, authors, journals, and keywords of the articles in this area by generating visualization graphs.

Results

A total of 127 articles were eligible, recorded by 78 journals, and drafted by 672 authors from 169 organizations in 26 countries/regions. The main type of these articles is randomized trial. Park Hee-Pyoung, Kim Hyun-Chang, and Cui Yuanshan are the most productive authors with 5 articles. Sichuan University, Seoul National University, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Capital Medical University, and Qingdao University published more articles on CRBD worldwide. China ranks No. 1 in terms of the number of publications, followed by South Korea and India. Journals specialized in anesthesiology, such as BMC Anesthesiology, Journal of Anesthesia, and British Journal of Anesthesia, are more popular with researchers in this area. The research hot spots of CRBD have concentrated on the prevention and treatment of CRBD.

Conclusion

Though formal research on CRBD started late, there is a rising tendency for the number of publications. Authors and academic teams from Asia have made significant contribution to CRBD. Journals specialized in anesthesiology are priorities for publishing articles. Previous studies mainly focused on the pharmacological and pharmacological methods to CRBD. However, CRBD is not fully settled. Either clinical or experimental studies are still needed to further improve CRBD.

Machine learning-based prediction of the risk of moderate-to-severe catheter-related bladder discomfort in general anaesthesia patients: a prospective cohort study

BACKGROUND

Catheter-related bladder discomfort (CRBD) commonly occurs in patients who have indwelling urinary catheters while under general anesthesia. And moderate-to-severe CRBD can lead to significant adverse events and negatively impact patient health outcomes. However, current screening studies for patients experiencing moderate-to-severe CRBD after waking from general anesthesia are insufficient. Constructing predictive models with higher accuracy using multiple machine learning techniques for early identification of patients at risk of experiencing moderate-to-severe CRBD during general anesthesia resuscitation.

METHODS

Eight hundred forty-six patients with indwelling urinary catheters who were resuscitated in a post-anesthesia care unit (PACU). Trained researchers used the CRBD 4-level assessment method to evaluate the severity of a patient's CRBD. They then inputted 24 predictors into six different machine learning algorithms. The performance of the models was evaluated using metrics like the area under the curve (AUC).

RESULTS

The AUCs of the six models ranged from 0.82 to 0.89. Among them, the RF model displayed the highest predictive ability, with an AUC of 0.89 (95%CI: 0.87, 0.91). Additionally, it achieved an accuracy of 0.93 (95%CI: 0.91, 0.95), 0.80 sensitivity, 0.98 specificity, 0.94 positive predictive value (PPV), 0.92 negative predictive value (NPV), 0.87 F1 score, and 0.07 Brier score. The logistic regression (LR) model has achieved good results (AUC:0.87) and converted into a nomogram.

CONCLUSIONS

The study has successfully developed a machine learning prediction model that exhibits excellent predictive capabilities in identifying patients who may develop moderate-to-severe CRBD after undergoing general anesthesia. Furthermore, the study also presents a nomogram, which serves as a valuable tool for clinical healthcare professionals, enabling them to intervene at an early stage for better patient outcomes.

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

Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block (SESPB) and pudendal nerve block (PNB) in reducing the incidence and score of CRBD. Methods: This study was conducted between November and December 2023. ASA I-III, fifty-four TURP patients were divided into two groups: Group 1 received SESPB (n = 27) and Group 2 received PNB (n = 27) under ultrasound guidance at the end of surgery. The incidence of CRBD, CRBD score, numerical rating scale (NRS) score, use of rescue analgesics, block performance time, first call for analgesics, patient satisfaction, and side effects were recorded for 24 h. Results: The incidence of CRBD was lowest at 33.3% and highest at 48.1% in Group 1 and lowest at 25.9% and highest at 48.1% in Group 2, with no significant difference between the groups at all measurement times. CRBD scores and NRS scores were low and similar between the two groups. Block performance times were 9 ± 1.7 min in SESPB and 20 ± 2.5 min in PNB, and there was a significant difference between the mean times (p < 0.001). Patient satisfaction was adequate and similar in both groups. Conclusions: SESPB demonstrated a similar decreasing effect to PNB on the incidence and scores of CRBD in the first 24 h following TURP operations. The duration of SESPB administration was shorter than PNB.