Effect of TENS on Bladder Tenesmus-related Pain and Patient Comfort After Urinary Surgery

Overview

Bladder tenesmu is defined as the need to urinate despite the person urinating and is associated with various causes such as bladder spasm, infection, stones, catheters. Catheters used in urinary surgeries can cause various complications, especially pain and discomfort. There is no sufficient study in the literature on bladder tenesmus caused by mechanical interactions related to urinary catheters, and this situation negatively affects patient comfort. Transcutaneous Electrical Nerve Stimulation (TENS) is an effective method of reducing pain with low-voltage electrical current. However, there are no studies on the application of TENS in the management of symptoms associated with bladder tenesmus after urinary surgery. This study aims to investigate the effect of TENS application on bladder tenesmus-related pain and patient comfort in the early postoperative period after urinary surgery.

Bladder tenesmus is defined as the condition where a person still feels the need to urinate even though they have urinated. It may be caused by a tumor growing in the bladder or pelvis, or it may be associated with other bladder problems such as bladder spasm and discomfort, retention, infection, stones, clots, and catheters. During urological surgery, urinary catheters are placed in patients to ensure patency of the urinary tract, and these catheters usually remain in place until the patient is mobilized after surgery. Although urinary catheter-related problems are reported in the literature as short-term and long-term problems depending on the duration of the catheter, these problems are classified as infectious and non-infectious complications. The most common urinary catheter complications have been reported to include anaphylaxis, cytotoxicity and hypersensitivity, symptomatic bacterial infection, catheter obstruction, hematuria, mechanical trauma (perforation and urine leakage), urethral fistula and urethral stenosis. In a systematic review by Hollingsworth et al., where the results of 37 studies were evaluated, it was reported that non-infectious complications related to urinary catheters were much higher than infection-related complications. In a multicenter study by Saint et al., it was reported that infections constituted 10.5% of urinary catheter-related complications, while non-infectious complications constituted 55.4%, and these complications included pain and discomfort, hematuria, and urgent need to urinate. There are many studies on the successful application of non-pharmacological agents in pain treatment. One of these methods is Transcutaneous Electrical Nerve Stimulation (TENS). TENS is a method of applying controlled, low-voltage electrical current to the nervous system through electrodes placed on the skin and is widely used for postoperative pain control. Bladder tenesmus caused by a urinary catheter creates a feeling of a full bladder, causing pain and discomfort with symptoms of urgency and inability to urinate. This negatively affects the patient's comfort. Although urinary catheter-related complications have been extensively investigated, no comprehensive review has been conducted focusing on identifying and analyzing the complication of bladder tenesmia and urgency caused by mechanical interaction due to the physical contact of the urinary catheter. There is also no application in the literature to relieve symptoms associated with bladder tenesmus caused by Foley catheters in patients after urinary surgery. Therefore, this study was planned to investigate the effect of TENS application on pain and patient comfort associated with bladder tenesmus in the early postoperative period after urinary surgery.