title: Does glycopyrrolate at anesthesia induction increase temporary postoperative urinary retention after a midurethral sling?
abstract: OBJECTIVE
  To determine whether patients receiving perioperative glycopyrrolate during midurethral sling surgery had more acute but temporary postoperative urinary retention.
  
  
  METHODS
  Retrospective cohort from 2006 to 2011.
  
  
  METHODS
  Northern Virginia community urology practice.
  
  
  METHODS
  To minimize variability in surgical technique and postoperative care, all cases were from a single fellowship-trained urologist who performed most of the female incontinence procedures. Inclusion criteria were charts of women, 18 years of age or older, who had a primary preoperative diagnosis of stress urinary incontinence (SUI) and who underwent a midurethral sling procedure. Of 151 patients charts, 135 met study eligibility: 57 (42.2%) patients received glycopyrrolate; 78 (57.8%) did not. The postoperative course of those who did and did not receive glycopyrrolate was compared and formed the basis of group allocation. Data collected included age, body mass index, incontinence type, smoking status, diabetes mellitus, surgery performed, anesthesia type, estimated blood loss, intraoperative fluids, surgery end time to void, and postoperative urinary retention.
  
  
  RESULTS
  No differences existed between the groups in baseline or surgical data. Seven patients (5.2%) had acute temporary postoperative retention, two of whom received glycopyrrolate and 5 did not (3.51% vs 6.41%; relative risk [RR] 0.55, 95% CI 0.11 -2.72, P = 0.70). Excluding those with continued persistent voiding dysfunction beyond 48 hours from surgery, only 3 patients (2.22%) had acute temporary postoperative urinary retention: one received glycopyrrolate and two did not (1.75% vs 2.56%; RR 0.68, 95% CI 0.064 - 7.36; P = 0.99).
  
  
  CONCLUSIONS
  Acute temporary postoperative urinary retention is rare after midurethral slings. Glycopyrrolate during anesthesia induction does not appear significantly to increase this rate.
authors.affiliation: Department of Obstetrics and Gynecology Division, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA. Electronic address: shana.m.miles@health.mil.
authors.forename: Shana
authors.initials: S
authors.lastname: Miles
authors.forename: Jason
authors.initials: J
authors.lastname: Massengill
authors.forename: Daniel
authors.initials: D
authors.lastname: Gruber
authors.forename: Karen Gabel
authors.initials: KG
authors.lastname: Speroni
authors.forename: Darlene
authors.initials: D
authors.lastname: Gaynor-Krupnick
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006024:Glycopyrrolate / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D053825:Suburethral Slings; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology*; D014768:Virginia; D055815:Young Adult
chemical_list: D018727:Muscarinic Antagonists; D006024:Glycopyrrolate
keywords: Anesthetics: antimuscarinic; Glycopyrrolate; Midurethral slings; Urinary retention