Catheter-related bladder discomfort (CRBD) is a frequently encountered problem especially after use of urethral catheter in male patients and has been reported to range from 47 to 90% with different types of surgeries. The pudendal nerve block (PNB) is widely used for regional anesthesia during obstetric and anorectal procedures, but its role in urologic procedures has not been thoroughly studied. The aim of this study was to evaluate the efficacy of pudendal nerve block on discomfort level of presence of urethral catheter in patients undergoing robot-assisted radical prostatectomy (RARP).

We prospectively collected and retrospectively evaluated the data regarding 30 consecutive patients undergoing RARP at single experienced robotic surgery center from 2017 to 2018 . RARP was performed in 30 patients and all patients received 20 Fr Foley catheter with a balloon inflated 15 mL. The patients were randomly divided into two groups either receiving pudendal nerve block group  (PDB-Group) and control group (C-Group). 
    Under fluroscopic view over pelvic region and using index finger guidance and ischial spine (IS) and sacrospinous ligament (SSL) was palpated through the rectal wall. Ischial spina is fixed with index finger and flouroscopy, subsequently 12 cm length spinal needle inserted percutenously until reaching to ischial spina and sacrospinous ligament. Bupivacaine 0.5% 10 mg and methylprednisolone 40 mg mixture was given at each side for PNB, beneath the IS and SSL where the pudendal neurovascular bundle has been localized, 
   Pain scores and degree of discomfort experienced were assessed by using self-reported validated questionnaires and with the Wong-Baker FACES (WB-FACES) immediately after the procedure and at postoperative  1, 2, 6, and 12 hours. The WB-FACES is consistent with the numeric rating scale of 0 to 10. To assess the CRBD we asked our patients additional 4 questions. ‘’Q1: Do you feel any pain on your penis? ‘’,’’Q2: Do you feel the catheter in your penis?’’, ‘’Q3: Do you have an urgency?’’, ‘’Q4: Do you feel any urge to urinate and but unable to urinate ? The answers were classified in four categories (none, mild, moderate, severe).

There was no perioperative or early post-operative major complication related to the intervention. Patients in PDB-Group had significantly lower postoperative pain intensity but similar WB-FACES  scores  when compared to the control group  at most of the measurement times and none of patients in PDB-Group had additional analgesic requirements up to 12 hours. Figure 1 shows pain and CRBD at immediate and early postoperative period in patients with or without bilateral PNB.

Combined use of marcaine and  prednisolone effectively reduced postoperative pain and CRBD  in our patient population when compared to control subjects. Significantly decreased postoperative CRBD by use of marcaine/prednisilone combination may provide further clinical insights in clinical management of CRBD especially after radical pelvic surgeries.

Our data suggested that use of PNB after RARP significantly decreases CRBD and pain after urinary catheterization. Relief of pain in the early postoperative period provides efficient patient comfort and may provide decreased analgesic use and thereby reduced hospital stays.