The Role of Anesthesia in Urinary Retention Following Mid Urethral Sling
Eric Katz, MD, Kareem Alazem, MD, Kristian Stensland, MD, Lara MacLachlan, MD
Lahey Hospital and Medical Center, Burlington, MA
BACKGROUND: Postoperative urinary retention is a known complication of mid urethral sling placement for stress urinary incontinence, occurring in 3-39% of cases. The use of certain perioperative medications may influence the risk of this complication. Antiemetics are commonly used to manage perioperative nausea, some of which also have anticholinergic properties. Additionally, muscle relaxants used for paralysis could impair detrusor function. The aim of this study was to investigate the association of perioperative medications with urinary retention in the perioperative period following mid urethral sling.
METHODS: This was a retrospective cohort study of all women undergoing mid urethral sling placement for stress urinary incontinence by a single fellowship-trained urologic surgeon at one institution between March 2015 and June 2018, under approval by the Institutional Review Board. Recorded data consisted of preoperative demographics and clinical data including voiding function, surgical data, intraoperative anesthesia and perioperative medications, and postoperative voiding function. Both retropubic and transobturator approaches were included. Exclusion criteria included incomplete surgical or perioperative data. All patients underwent an active retrograde void trial in the recovery area on the day of surgery. Retention rates were compared with Fisher’s Exact test.
RESULTS: 82 patients were included, 17 (21%) of whom failed postoperative void trial. All of these women eventually passed a void trial, with no cases of permanent retention. A total of 25 patients received transdermal scopolamine and 40% of those patients receiving scopolamine failed the postoperative void trial (p=0.048). There was no statistically significant association between other antiemetics (Ondansetron, Promethazine) and urinary retention. Rate of retention was also higher in patients undergoing retropubic vs. transobturator approach (36% vs. 9%; p=0.005). Administration of a muscle relaxant for anesthesia (rocuronium or vecuronium) was additionally associated with urinary retention (28% vs. 13% with muscle relaxant vs. no paralysis, respectively), though this association was not statistically significant (p=0.16). Last, the rate of retention was lower in patients on preoperative preoperative antidepressants (p=0.03).
CONCLUSIONS: Perioperative administration of transdermal scopolamine is associated with increased risk of urinary retention after mid urethral sling. This correlation is not seen with other common antiemetics and may provide a new avenue for minimizing postoperative complications. Retropubic approach, muscle relaxation, and absence of preoperative antidepressants may also correlate with higher rate of retention. Further studies are needed to elucidate these relationships.
Back to 2019 Abstracts