Research at AHN Women’s Institute is Reducing Pain and Improving Outcomes After Midurethral Sling Placement

A recent study conducted by experts at AHN Women’s Institute found that injecting lidocaine during midurethral sling (MUS) surgery for stress urinary incontinence (SUI) significantly improved postoperative pain scores and patient satisfaction.

As part of AHN’s ongoing commitment to advancing women’s health through pioneering research and breakthrough treatments, these findings mark a significant milestone in urogynecologic care.

Study design

The study, published by the American Urogynecologic Society, was a randomized, double-blind and placebo-controlled trial of 150 participants ages 44 to 63 undergoing MUS procedures between 2020 and 2024 at AHN facilities in the Pittsburgh region.

In the medication group, patients received retropubic injections of lidocaine with epinephrine at the time of procedure. The placebo group received normal saline with epinephrine. All participants were asked to void their bladder two hours after surgery and to record their pain levels using Visual Analog Scales (VAS) following hospitalization.

Key findings

Most notably, the study found that lidocaine injections did not increase postoperative urinary retention (POUR), which is common after MUS placement. The lidocaine did, however, provide benefits including: 

• Improved pain scores: Patients reported lower VAS scores at two and six hours post-surgery.
• Reduced NSAID use: Lidocaine patients used fewer analgesic drugs on the first day after surgery.
• Increased surgical satisfaction: Nearly 91% of patients in the lidocaine group reported satisfaction at six weeks post-op compared to only 77.3% in the control group.  

“With lower pain scores, decreased medication use, and increased satisfaction overall, we believe this study shows that lidocaine injections should strongly be considered in all MUS procedures,” said Jessica Sassani, MD, urogynecologist at AHN and co-lead researcher of the trial.

Significance for women's health

SUI impacts roughly 18 million women in the U.S., yet many do not seek care, believing it is a normal part of the aging process. SUI can happen due to common causes like pregnancy and childbirth, obesity, smoking, genetics, and hormonal changes like the menopause transition.

Though MUS is considered the gold standard treatment for SUI, about 10 to 15% of all women experience POUR for several days postoperatively, which requires the use of a catheter and increases risk of UTIs and subsequent pain.

The success of lidocaine in improving outcomes without additional side effects can help guide patients and providers in MUS recommendations and recovery plans.

“We hope that with the ability to make procedures like MUS more comfortable, more women will feel confident in taking control of their health and getting care that can truly change their lives,” said Dr. Sassani.

How to refer

For patients where lifestyle changes, pelvic floor therapy, electrical stimulations, or other methods have not adequately managed SUI, or if pads or adult diapers have become a part of a woman’s care plan, consider referring them to urogynecology specialists at AHN Women’s Institute for MUS placement. Call (412) DOCTORS 412-362-8677 or make a referral online.