Alabama College of Osteopathic Medicine, Dothan, AL, USA.
Crestwood Medical Center, Huntsville, AL, USA.
Int Urogynecol J. 2023 Aug;34(8):1689-1696. doi: 10.1007/s00192-023-05467-8. Epub 2023 Jan 31.
Both urogynecologic surgeries and transdermal scopolamine (TDS) patches are independently associated with postoperative urinary retention (POUR). It is unclear if the risk of POUR increases when these interventions are used in combination. This systematic review and meta-analysis aim to synthesize current evidence to optimize clinical management and outcomes for patients undergoing urogynecologic procedures.
This systematic review was conducted in concordance with the PRISMA 2020 guidelines. MEDLINE, ClinicalTrials.gov, and Cochrane Library were searched. Publications were filtered by inclusion and exclusion criteria. Inclusion criteria required: (1) preoperative or perioperative application of TDS, (2) surgery indicated for stress urinary incontinence and/or pelvic organ prolapse, (3) results given for postoperative voiding trials, and (4) were available in English. Exclusion criteria included: (1) oral or parenteral formulations of scopolamine, (2) administration of alternative preoperative antiemetics, and (3) use of combination antiemetic therapy. Quality was assessed using the Joanna Briggs Institute Checklist. Publication bias was evaluated via the ROBINS-I assessment tool, and Egger regression and Begg and Mazumumdar rank correlation tests. A meta-analysis was conducted using Meta-Essentials Excel Workbook.
Four publications were identified which complied with inclusion and exclusion criteria. Included studies comprised 752 patients (237 experimental group, 515 control group). All were retrospective cohort studies conducted via chart review in America. Meta-analysis revealed a risk ratio (RR) of 2.35 with a confidence interval (CI) of 0.61 to 9.07, indicating a positive association between TDS and POUR, but without statistical significance.
Current evidence suggests that TDS application may be associated with increased risk of POUR following urogynecologic procedures. While research on this topic is greatly limited, this systematic review and meta-analysis highlights that alternative antiemetic therapy may be necessary for patients undergoing such interventions in effort to limit the risk of POUR.
尿妇科手术和透皮东莨菪碱（TDS）贴剂均与术后尿潴留（POUR）独立相关。当这些干预措施联合使用时，POUR 的风险是否增加尚不清楚。本系统评价和荟萃分析旨在综合当前证据，以优化接受尿妇科手术患者的临床管理和结局。
本系统评价按照 PRISMA 2020 指南进行。检索 MEDLINE、ClinicalTrials.gov 和 Cochrane Library。通过纳入和排除标准筛选出版物。纳入标准要求：（1）术前或围手术期应用 TDS，（2）手术指征为压力性尿失禁和/或盆腔器官脱垂，（3）术后排尿试验结果，（4）用英文发表。排除标准包括：（1）东莨菪碱的口服或胃肠外制剂，（2）替代术前止吐药的应用，（3）联合止吐治疗的应用。使用 Joanna Briggs 研究所清单评估质量。使用 ROBINS-I 评估工具、Egger 回归和 Begg 和 Mazumumdar 等级相关检验评估发表偏倚。使用 Meta-Essentials Excel 工作簿进行荟萃分析。
确定了 4 篇符合纳入和排除标准的出版物。纳入的研究包括 752 名患者（实验组 237 名，对照组 515 名）。所有研究均为在美国通过病历回顾进行的回顾性队列研究。荟萃分析显示，TDS 与 POUR 之间存在正相关关系，风险比（RR）为 2.35，置信区间（CI）为 0.61 至 9.07，但无统计学意义。
目前的证据表明，TDS 应用可能与尿妇科手术后 POUR 风险增加相关。尽管该主题的研究受到极大限制，但本系统评价和荟萃分析强调，对于接受此类干预的患者，可能需要替代止吐治疗，以限制 POUR 的风险。
