Researchers reported that lidocaine did not affect POUR rates but enhanced early recovery metrics after SUI surgery.
Retropubic lidocaine administered during midurethral sling (MUS) surgery improved postoperative pain and patient satisfaction without increasing urinary retention, according to a randomized controlled trial published in Urogynecology in February 2026.¹ The findings, reported by researchers at the Allegheny Health Network Women’s Institute, suggested the intervention could meaningfully improve recovery for women undergoing surgery for stress urinary incontinence (SUI).²
Postoperative urinary retention (POUR) is common following MUS placement and can be distressing for patients.¹Although MUS is considered the gold standard surgical treatment for SUI, approximately 10–15% of women experience difficulty emptying their bladder in the days after surgery and may require temporary catheterization, increasing discomfort and infection risk, according to the study authors, led by Jessica Sassani, MD, Charlie Miller, MD, and Lindsay Turner, MD.²
To evaluate whether local anesthetic use affected retention rates, investigators conducted a double-blind, placebo-controlled trial between 2020 and 2024 across AHN facilities in the Pittsburgh region.¹² The study randomized 150 women undergoing MUS placement, with or without anterior repair, to receive 20 mL of retropubic 0.5% lidocaine with epinephrine or normal saline with epinephrine.¹ The primary outcome was a failed postoperative retrograde voiding trial.
Participants had a mean age of 51.5 years and a mean body mass index of 29.0. Most were White (94.0%), postmenopausal (54.0%), and multiparous (95.3%).
Rates of POUR were similar between groups, occurring in 20.0% of women in the lidocaine arm and 18.7% in the saline arm (P = 0.84). The findings demonstrated that lidocaine did not increase the incidence of urinary retention following surgery.¹²
Significant differences emerged in postoperative pain outcomes. Women in the saline group reported higher Visual Analog Scale (VAS) scores at both 2 hours and 6 hours after surgery (2 h 21 [10-42] vs 11 [0-28], P = 0.008; 6 h 25 [13-50] vs 18 [9-33], P = 0.03).¹
Saline recipients were also more likely to use nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative day 1 (76.2% vs 52.3%; P = 0.005) and reported higher “worst pain in the first 24 hours” scores (6 vs 4; P = 0.013)¹.
At 6 weeks postoperatively, 90.7% of women in the lidocaine group reported being satisfied or very satisfied with their surgical outcome compared with 77.3% in the saline group (P = 0.03)¹.
“This research represents an exciting advancement in understanding POUR among this patient population,” said Turner in the press release. “These findings will further guide urogynecologists providing life-changing procedures for women with urinary incontinence.”²
SUI affects roughly 18 million women in the United States, occurring when the urethral sphincter and pelvic floor muscles weaken due to factors such as pregnancy, childbirth, obesity, smoking, genetics, and menopause, leading to urine leakage during coughing, sneezing, laughing, or exercise.
“Unfortunately, many [women] do not seek treatment simply because they believe in the common misconception that it’s a normal part of the aging process or a common side effect of pregnancy,” added Sassani. “However, there are several lifestyle modifications that can be made which can provide relief, as well as pelvic floor therapy, weight-based exercises and electrical stimulations.”
When conservative therapies fail, MUS placement offers minimally invasive surgical support under the urethra to reduce leakage. Prior concerns suggested that lidocaine injections to control pain might influence bladder emptying, but the current trial did not support that assumption.
“The lidocaine group reported less use of pain medications, lower postoperative pain scores and improved overall patient satisfaction,” said Sassani. “In addition, there was a statistically significant reduction in pain with lidocaine compared with saline at both 2 hours and 6 hours postoperatively. Therefore, we believe that this study shows that lidocaine injections should be strongly considered in all MUS procedures.”
The authors concluded that retropubic lidocaine did not increase urinary retention but significantly improved early postoperative pain control and patient satisfaction, supporting its routine consideration during MUS surgery.¹²
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