A Comparison of the Effects of General Anesthesia Versus Spinal Anesthesia on Catheter-Related Bladder Discomfort after Holep: A Prospective Trial

Abstract

Background and objective Using an indwelling urinary catheter during lower urinary tract surgeries frequently leads to catheter-related bladder discomfort (CRBD) in the immediate postoperative period. The purpose of the present study was to compare the effectiveness of general and spinal anesthesia on CRBD in patients who underwent Holmium laser enucleation of the prostate (HoLEP). Material and methods This clinical trial included male patients who underwent HoLEP for benign prostatic hyperplasia. Forty-five participants were divided into two groups: general anesthesia and spinal anesthesia. The incidence and the severity of CRBD were assessed postoperatively for 24 h. The severity of CRBD was graded using an 11-point scale (0 = no CRBD, 10 = worst CRBD imaginable). Moderate to severe CRBD, having a score of ≥4, was treated with 1 μg/kg fentanyl incrementally every 5 min during immediate postoperative period, and the total consumption was compared between the two groups. Results The overall incidence of CRBD 24 h following HoLEP was 80% in the general anesthesia group, which was significantly higher than that of the spinal anesthesia group (p = 0.017). The severity of CRBD was significantly lower in the spinal anesthesia group compared with the general anesthesia group postoperatively at 2 and 6 h (p < 0.001 and p = 0.005 respectively). Furthermore, opioid consumption was significantly higher in the general anesthesia group compared with the spinal anesthesia group (p = 0.009). Conclusion Spinal anesthesia has a CRBD-reductive effect compared with general anesthesia during the early postoperative hours following HoLEP.

Keywords

• benign prostatic hyperplasia
• recovery
• urinary catheter