Effect of Scopolamine Patch Use on Postoperative Voiding Function After Transobturator Slings

Abstract

Objectives The aim of this study was to determine whether the use of a pre-operative transdermal scopolamine patch for post-operative nausea and vomiting prophylaxis affects the success of a voiding trial after a transobturator tape sling procedure. Methods This study is a retrospective cohort study of adult women who underwent a transobturator tape sling procedure without concomitant procedures from February 1, 2009 through August 1, 2010. The exposed group included all eligible women who received a pre-operative transdermal scopolamine patch. For each exposed woman, we selected the next two consecutive eligible women who did not receive a transdermal scopolamine patch to be included in the unexposed group. The primary outcome was post-operative voiding trial failure. Results We identified 35 women who met eligibility criteria and used a pre-operative transdermal scopolamine patch, and included 70 women who did not use a pre-operative transdermal scopolamine. A significantly higher proportion of women in the transdermal scopolamine patch group (54.3%) failed their voiding trial than in the group that did not receive transdermal scopolamine (7.1%, P=<0.001). A history of an incontinence procedure, older age and higher body mass index strengthened the association between transdermal scopolamine patch and voiding trial failure. The adjusted model yielded a risk ratio for voiding trial failure of 13.8 (95% CI: 5.2-36.5) for women who received transdermal scopolamine patch compared to those who did not. Conclusions The results of this study demonstrate that use of transdermal scopolamine patches for postoperative nausea and vomiting prophylaxis may negatively affect the success of voiding trials after transobturator tape sling procedures.

The role of perioperative medications in urinary retention following midurethral sling

“…Also, their treatment group was similar to ours in that it was younger, reinforcing the utility of perioperative antiemetics in younger patients. The only other study to investigate scopolamine in pelvic reconstructive surgery focused on patients undergoing transobturator MUS 2 . They retrospectively compared 35 women in the exposed group receiving a preoperative transdermal scopolamine patch at a 2:1 ratio with an unexposed control group of women not receiving the patch.…”

“…Postoperative urinary retention (PUR) is a well‐known complication of midurethral sling (MUS) that affects 2.8–39% of cases 1–4 . While this is typically a transient complication, it nonetheless decreases patient satisfaction and increases the risk of urinary tract infections and health care costs 3 .…”

“…Many studies have investigated patient‐related factors that influence the likelihood of PUR. These include preoperative uroflowmetry parameters, such as elevated postvoid residual (PVR) and low maximal flow rate; concomitant prolapse surgery or history of prolapse surgery; elevated body mass index (BMI); and advanced age 1,2,4,5 . Notably, all of these factors are out of the control of the surgeon.…”

“…It is important, though, to recognize any unintended adverse effects of antiemetics. Specifically, scopolamine has antimuscarinic anticholinergic effects and can cause dry mouth, visual disturbances, cognitive effects, and urinary retention 2,10 . The data on scopolamine and PUR in female pelvic surgery is limited and inconclusive.…”

“…The data on scopolamine and PUR in female pelvic surgery is limited and inconclusive. While scopolamine was not associated with PUR in a broad cohort of women undergoing surgery for SUI and pelvic organ prolapse (POP), it was in fact linked to PUR after transobturator MUS 2,11 …”