Does Spinal Anesthesia for Prolapse Surgery With Lead to Urinary Retention?

A randomized trial to compare urinary retention rates between spinal and general anesthesia
in women who undergo outpatient pelvic organ prolapse surgery with concomitant incontinence
surgery.

Randomization

Randomization will be done in the pre-operative area, on the day of surgery. Computer
generated randomization will be done in blocks of 4. Sealed numbered envelopes will be
opened prior to surgery and the subject will then be assigned to spinal or general
anesthesia. Patient randomization on day of surgery was discussed with anesthesia and it
thought that randomizing on the same day would be safe.

Preoperatively

Subjects will be asked to complete a validated questionnaire, the Quality of Recovery 15
(QoR-15) prior to surgery, at their preoperative visit.

Anesthesia

Subjects randomized to general anesthesia will receive propofol induction, in combination
with a muscle relaxant and inhalational gas per anesthesia standard of care at the
investigators' institution.

Subjects randomized to spinal anesthesia will receive Bupivacaine 0.75%, 8-12 mg dose
depending on estimated duration of surgery and anesthesiologist decision. In addition to
spinal anesthesia, these subjects will possibly have concurrent administration of fentanyl,
midazolam, and propofol so that they are mildy sedated or sleeping.

Voiding Trial

A voiding trial will be performed in the PACU once the subjects are able to stand and
ambulate to the bathroom. Voiding trial will consist of removing the vaginal packing and
back filling the bladder with 300cc of saline or less if subject has urgency or a smaller
bladder capacity. A voiding trial is considered successful if the subject voids at least 2/3
of the total volume instilled and has a bladder scan showing less than 1/3 remaining. If a
subject is unable to void after an hour, an additional hour will be permitted. However,
after 2 hours from when the bladder was backfilled the subject is still unable to void, the
Foley will be replaced and the subjects will be discharged home with a Foley leg bag and leg
bag teaching.

An office nurse will call the subject and schedule an office nurse visit to remove the Foley
between post-operative day number 5 to 7. If the subject goes home with a Foley this will be
considered acute POUR.

Follow Up

Subjects will receive a phone call from either a nurse or fellow, between 48 to 72 hours
post-operatively to make sure they are having no symptoms of urinary retention, are doing
well and are not having any complications. A telephone survey will be administered during
this follow up phone call using a validated questionnaire, the QoR-15. They will have
received a copy of this survey to refer to at the time of their hospital discharge.

Subjects who were admitted to the hospital will have the same follow up, including a phone
call 48 to 72 hours after their surgery, including the validated questionnaire, the QoR-15.

In addition, subjects will have a 6 week follow up visit in the clinic and will be asked to
complete the QoR-15.

Inclusion Criteria:

1. Women over the age of 40

2. Women scheduled for pelvic organ prolapse surgery as well as concomitant incontinence
sling surgery

3. Post-void residual <150 cc prior to surgery

4. Surgery length of at least 1 hour

5. BMI <40

6. ASA class 1-2

Exclusion Criteria:

1. Contraindications to surgery

2. Contraindications to outpatient surgery, and requiring inpatient stay for medical
comorbidities. The decision for a required inpatient stay will be decided prior to
surgery based on the recommendations of the patient's primary care physician or
specialist, such as cardiology or pulmonology.

3. BMI >40

4. ASA class 3 or 4 that would be a contraindiction to both spinal or general anesthesia

5. Evidence of voiding dysfunction or urinary retention on pre-operative urodynamics,
including PVR >150, or dyssynergic sphincter dyssynergia

6. Neurological diseases that can interfere with spinal anesthesia

7. Anticoagulation therapy within a week of surgery

8. History of back surgery that would prevent successful spinal anesthesia

9. History of back deformity, such as scoliosis that would prevent successful spinal
anesthesia