Tanya P Hoke1, Howard Goldstein2, Emily K Saks2, Babak Vakili2. 1. Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware. 2. Center for Urogynecology and Pelvic Surgery, Christiana Care Health System, Newark, Delaware.
Abstract
AIMS: The purpose of this study is to determine whether a transvaginal trigonal block immediately preceding cystoscopy with hydrodistention yields an additional therapeutic benefit compared to cystoscopy with hydrodistention alone for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: A retrospective chart review was performed at a single-center. Performance of a trigonal block prior to hydrodistention was at the discretion of the surgeon. A trigonal block consists of injecting 0.25% bupivacaine with 1.0% Xylocaine into the anterior vagina under the trigone under cystoscopic guidance. Procedures between January 1, 2008 and December 31, 2013 were included. The primary outcome compared change in pain score from the baseline to 1-month post-operative. RESULTS:One hundred and eighty-three patients underwent hydrodistention of the bladder. Seventy-seven were excluded and of the 106 patients remaining, 48 received a trigonal block and 58 did not. Both groups had a significant improvement in pain scores (P < 0.0001). There was no difference in change in pain score from baseline between both groups (-2.9 vs. -2.6; P = 0.694). Distention time was dichotomized into 2 and >5 min based on surgeon preference. There was no difference in change in pain score from baseline between both groups (-3.0 vs. -2.2; P = 0.061). CONCLUSIONS: Hydrodistention of the bladder decreased pain postoperatively regardless of trigonal block or time of distention. A randomized-controlled trial is necessary to determine the benefits of duration of hydrodistention or performance of a block. Neurourol. Urodynam. 36:784-786, 2017.
RCT Entities:
AIMS: The purpose of this study is to determine whether a transvaginal trigonal block immediately preceding cystoscopy with hydrodistention yields an additional therapeutic benefit compared to cystoscopy with hydrodistention alone for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: A retrospective chart review was performed at a single-center. Performance of a trigonal block prior to hydrodistention was at the discretion of the surgeon. A trigonal block consists of injecting 0.25% bupivacaine with 1.0% Xylocaine into the anterior vagina under the trigone under cystoscopic guidance. Procedures between January 1, 2008 and December 31, 2013 were included. The primary outcome compared change in pain score from the baseline to 1-month post-operative. RESULTS: One hundred and eighty-three patients underwent hydrodistention of the bladder. Seventy-seven were excluded and of the 106 patients remaining, 48 received a trigonal block and 58 did not. Both groups had a significant improvement in pain scores (P < 0.0001). There was no difference in change in pain score from baseline between both groups (-2.9 vs. -2.6; P = 0.694). Distention time was dichotomized into 2 and >5 min based on surgeon preference. There was no difference in change in pain score from baseline between both groups (-3.0 vs. -2.2; P = 0.061). CONCLUSIONS: Hydrodistention of the bladder decreased pain postoperatively regardless of trigonal block or time of distention. A randomized-controlled trial is necessary to determine the benefits of duration of hydrodistention or performance of a block. Neurourol. Urodynam. 36:784-786, 2017.