Division of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts.
Neurourol Urodyn. 2020 Nov;39(8):2455-2462. doi: 10.1002/nau.24516. Epub 2020 Sep 17.
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.
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.
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).
Perioperative scopolamine may be associated with an increased risk of postoperative urinary retention following MUS, especially in the setting of a concomitant prolapse surgery.
术后尿潴留（PUR）是尿道中段吊带（MUS）置入的已知并发症。某些围手术期药物的使用可能会影响这种并发症的风险。本研究旨在调查围手术期药物与 MUS 后尿潴留的关系。
这是一项回顾性研究，研究对象为 2015 年至 2018 年间由一名接受过 fellowship培训的泌尿科医生行 MUS 治疗压力性尿失禁的女性患者，该研究已获得机构审查委员会的批准。纳入了经耻骨后和经闭孔两种入路的患者。所有患者术后均行主动排尿试验。回顾性记录麻醉团队术中给予的药物。采用 Fisher 确切检验比较 PUR 与分类变量的相关性。
共纳入 82 例患者，其中 17 例（21%）因术后尿潴留而未能通过术后排尿试验。在接受围手术期东莨菪碱治疗的 25 例患者中，40%的患者未能通过术后排尿试验，而未接受东莨菪碱治疗的患者中，有 12%的患者未能通过术后排尿试验（p=0.048）。由于观察到东莨菪碱与 PUR 有独立相关性，因此根据东莨菪碱的使用情况对两组进行分层。亚组分析显示，在同时行脱垂手术的患者中，术后保留与东莨菪碱的相关性更强。值得注意的是，无论患者单独行吊带置入术还是与脱垂手术联合，保留率和东莨菪碱使用率均相似。经耻骨后入路的吊带保留率也高于经闭孔入路（36% vs. 9%；p=0.005）。
围手术期东莨菪碱的使用可能与 MUS 后术后尿潴留的风险增加相关，尤其是在同时行脱垂手术的情况下。
