The Effect of Phenazopyridine on Immediate Postoperative Voiding After Prolapse Surgery: A Randomized Controlled Trial

Abstract

Objectives The objective of our study was to determine if phenazopyridine reduces void trial (VT) failure rates after prolapse surgery. Methods A single-institution randomized controlled trial was conducted comparing a second dose of phenazopyridine 200 mg on postoperative day 1 versus no additional phenazopyridine in women undergoing prolapse surgery. All subjects (including controls) received 200 mg of phenazopyridine preoperatively for ureteral patency verification. The intervention group received a second dose of phenazopyridine 200 mg the morning of postoperative day 1. The primary outcome was assessed using a standardized VT. Secondary outcomes included pain, opioid usage, urinary tract infections, and prolonged or recurrent urinary retention. An intent-to-treat analysis was performed with a χ2 test to compare failure rates between the intervention and control groups. Results We enrolled 152 women, and 76 were randomized to each group. There was no difference in VT failures between the 2 groups—34% failed without phenazopyridine on postoperative day 1, and 42% failed with phenazopyridine on postoperative day 1 (P = 0.326). Subject characteristics were similar across both groups. Pain scores immediately before the VT were 3 out of 10 in both groups (P = 0.206), with no difference in opioid consumption (P = 0.750). There were no differences in the rate of urinary tract infections or prolonged or recurrent urinary retention between the groups (P = 0.304 and P = 0.745). Conclusions While previous studies suggested an improvement in immediate postoperative voiding with phenazopyridine, our randomized controlled trial does not support this.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

“…Another pharmacological option used in FPMRS surgery is phenazopyridine. This may be administered orally in the immediate preoperative period to aid in intraoperative visualization of ureteral efflux, though data are inconsistent whether there is improvement of postoperative voiding 89,90 …”

“…This may be administered orally in the immediate preoperative period to aid in intraoperative visualization of ureteral efflux, though data are inconsistent whether there is improvement of postoperative voiding. 89,90 There are limited data to guide use of nonpharmacological therapies such as transcutaneous electrical nerve stimulation, acupuncture, massage, and cognitive behavioral therapies. In an RCT specific to FPMRS, utilizing music and landscape imagery made no difference in postoperative pain scores but did have a positive effect on the postoperative experience.…”

“…PONV is one of the most common postoperative complications for patients undergoing surgery, independent of general versus regional anesthesia, and can be both distressing to the patient and delay discharge. 90 Identifying patients at risk of PONV prior to surgery allows for optimization of perioperative medications that minimize patient morbidity and dissatisfaction. Female gender, non-smoking status, and use of postoperative opioids are all risk factors for PONV as measured by the Apfel score.…”

Postoperative Urinary Retention

“…The use of opioids and tricyclic antidepressants in patients undergoing a hysterectomy was found to be associated with POUR 63 . Three RCTs in patients that had POP or SUI surgery showed no differences in using phenazopyridine to decrease the incidence of POUR 24,66,67 …”

“…RCTs have demonstrated that the use of phenazopyridine does not decrease the risk of POUR in patients having MUS or pelvic organ prolapse surgical procedures. 24,66,67 87.50…”