The role of perioperative medications in urinary retention following midurethral sling

Abstract

Aims: Postoperative urinary retention (PUR) is a known complication of midurethral sling (MUS) placement. The use of certain perioperative medications may influence the risk of this complication. This study aimed to investigate the association of perioperative medications with urinary retention after MUS. Methods: This was a retrospective study of women undergoing MUS placement for stress urinary incontinence by a fellowship-trained urologic surgeon between 2015 and 2018, under approval by the Institutional Review Board. Both retropubic and transobturator approaches were included. All patients underwent an active void trial following surgery. Intraoperative medications given by the anesthesia team were retrospectively noted. The Fisher's exact test was used to compare the association of PUR with categorical variables. Results: A total of 82 patients were included, 17 (21%) of whom failed postoperative void trial due to urinary retention. Of 25 patients receiving perioperative scopolamine, 40% failed the postoperative void trial, compared to 12% of patients not receiving scopolamine (p = .048). Groups were then stratified based on scopolamine use due to the observed independent association with PUR. Subgroup analysis revealed a stronger association of postoperative retention with scopolamine in patients undergoing concomitant prolapse surgery. Notably, retention rate and scopolamine use were similar whether patients underwent sling placement alone or in combination with prolapse surgery. Rate of retention was also higher for retropubic versus transobturator slings (36% vs. 9%; p = .005). Conclusions: Perioperative scopolamine may be associated with an increased risk of postoperative urinary retention following MUS, especially in the setting of a concomitant prolapse surgery.

Postoperative Urinary Retention

“…Short-acting antimuscarinics used during MUS procedures, such as glycopyrrolate, may not affect POUR, but data are limited 131 . Halothane suppresses detrusor contractions, increases bladder capacity, and causes an inhibition of the pontine micturition center and voluntary control of the cortex on the bladder 15,59,60 . The data are conflicting regarding the preoperative application of transdermal scopolamine patches as a cause of POUR 59,61 …”

“…[55][56][57][58]129,130 Muscle relaxants are used to facilitate tracheal intubation by providing skeletal muscle relaxation and limited data exist on their effect on POUR. 59 Antimuscarinics reduce salivary, tracheal, and pharyngeal secretions, and reduce the free acid of gastric secretions. A single study found that atropine, with a half-life of 2 hours, increased POUR by a factor of 6.…”

“…131 Halothane suppresses detrusor contractions, increases bladder capacity, and causes an inhibition of the pontine micturition center and voluntary control of the cortex on the bladder. 15,59,60 The data are conflicting regarding the preoperative application of transdermal scopolamine patches as a cause of POUR. 59,61 Patient consumption of other medications given around the time of surgery, such as opioids, medications with anticholinergic properties, and phenazopyridine, may also contribute to POUR.…”

“…15,59,60 The data are conflicting regarding the preoperative application of transdermal scopolamine patches as a cause of POUR. 59,61 Patient consumption of other medications given around the time of surgery, such as opioids, medications with anticholinergic properties, and phenazopyridine, may also contribute to POUR. Limited data exist on the extent to which drugs that are known to cause chronic urinary retention may cause acute POUR if given perioperatively.…”