Does glycopyrrolate at anesthesia induction increase temporary postoperative urinary retention after a midurethral sling?

摘要

Study Objective To determine whether patients receiving perioperative glycopyrrolate during midurethral sling surgery had more acute but temporary postoperative urinary retention. Design Retrospective cohort from 2006 to 2011. Setting Northern Virginia community urology practice. Measurements To minimize variability in surgical technique and postoperative care, all cases were from a single fellowship-trained urologist who performed most of the female incontinence procedures. Inclusion criteria were charts of women, 18 years of age or older, who had a primary preoperative diagnosis of stress urinary incontinence (SUI) and who underwent a midurethral sling procedure. Of 151 patients charts, 135 met study eligibility: 57 (42.2%) patients received glycopyrrolate; 78 (57.8%) did not. The postoperative course of those who did and did not receive glycopyrrolate was compared and formed the basis of group allocation. Data collected included age, body mass index, incontinence type, smoking status, diabetes mellitus, surgery performed, anesthesia type, estimated blood loss, intraoperative fluids, surgery end time to void, and postoperative urinary retention. Main Results No differences existed between the groups in baseline or surgical data. Seven patients (5.2%) had acute temporary postoperative retention, two of whom received glycopyrrolate and 5 did not (3.51% vs 6.41%; relative risk [RR] 0.55, 95% CI 0.11 -2.72, P = 0.70). Excluding those with continued persistent voiding dysfunction beyond 48 hours from surgery, only 3 patients (2.22%) had acute temporary postoperative urinary retention: one received glycopyrrolate and two did not (1.75% vs 2.56%; RR 0.68, 95% CI 0.064 - 7.36; P = 0.99). Conclusion Acute temporary postoperative urinary retention is rare after midurethral slings. Glycopyrrolate during anesthesia induction does not appear significantly to increase this rate.