Glycopyrrolate and Urinary Retention After Laparoscopic Prolapse Surgery.

Area of Science:

• Urogynecology
• Anesthesiology
• Surgical Outcomes

Background:

• Postoperative urinary retention (POUR) is a common complication after urogynecologic surgery.
• Intraoperative glycopyrrolate may increase POUR risk in other surgical fields.
• Prolapse surgery has higher baseline POUR rates and often involves same-day discharge.

Purpose of the Study:

• To assess the association between intraoperative glycopyrrolate and POUR in patients undergoing laparoscopic prolapse repair.
• To evaluate POUR risk in the context of same-day discharge procedures.

Main Methods:

• Retrospective cohort study of 321 patients undergoing outpatient laparoscopic prolapse repair (sacrocolpopexy, sacrocervicopexy, sacrohysteropexy).
• Standardized postoperative voiding trial with 300 mL saline instillation and a 15-minute voiding window.
• Exposure: intraoperative glycopyrrolate; Outcome: POUR (<200 mL voided).
• Log-binomial regression adjusted for confounders.

Main Results:

• 77% of patients received intraoperative glycopyrrolate.
• Glycopyrrolate use was associated with increased POUR risk (RR: 1.93, 95% CI; 1.16 to 3.22).
• A dose-dependent relationship was observed, with higher doses showing a greater RR (high dose RR: 2.57, 95% CI; 1.51 to 4.38).

Conclusions:

• Intraoperative glycopyrrolate significantly increases POUR risk in laparoscopic prolapse repair.
• Higher doses of glycopyrrolate, often used for neuromuscular blockade reversal, pose a greater risk.
• Collaboration between surgeons and anesthesiologists is crucial to mitigate drug-related postoperative complications.