Glycopyrrolate and Urinary Retention After Laparoscopic Prolapse Surgery

Postoperative urinary retention (POUR) is a frequent and burdensome complication following urogynecologic surgery. Studies in other specialties suggest intraoperative glycopyrrolate may increase POUR risk; however, this association has not been explored in prolapse surgery, where baseline rates of POUR are higher and same-day surgery is now standard.

The objective of this study was to evaluate the association between intraoperative glycopyrrolate and POUR among patients undergoing laparoscopic prolapse repair with same-day discharge.

We conducted a retrospective cohort study of patients undergoing outpatient laparoscopic sacrocolpopexy, sacrocervicopexy, or sacrohysteropexy surgery from June 2017 through January 2024. All patients underwent a standardized postoperative voiding trial with 300 mL of saline instilled through a transurethral catheter, followed by a void within 15 minutes. The exposure was intraoperative glycopyrrolate; the primary outcome was POUR, defined as voiding <200 mL. Log-binomial regression was used to estimate relative risk (RR) and 95% CI, adjusting for age, body mass index, surgeon, concomitant sling, and perioperative scopolamine use.

Among 321 patients, 77% received glycopyrrolate. After adjusting for confounders, patients who received glycopyrrolate had an increased risk of POUR (RR: 1.93, 95% CI; 1.16 to 3.22) compared with those who did not receive glycopyrrolate. This relationship may be dose-dependent: patients who received a low dose had an RR of 1.28 (95% CI; 0.70 to 2.33), while those receiving a high dose had an RR of 2.57 (95% CI; 1.51 to 4.38).

Intraoperative glycopyrrolate was associated with a significantly increased POUR risk, particularly at higher doses commonly used during neuromuscular blockade reversal. Surgeons should engage with anesthesiologists to discuss the potential effect of drugs on postoperative outcomes.