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Introduction <p>Postoperative urinary retention (POUR) is common after inguinal hernia repairs (IHR). General anesthesia often utilizes paralytic agents such as vecuronium and rocuronium, which are subsequently reversed with neostigmine upon surgery completion. Neostigmine has undesired cholinergic effects, however, and is typically co-administered with glycopyrrolate, an anticholinergic agent which can impair bladder contraction, leading to urinary retention. Early studies have investigated sugammadex, an alternative reversal agent without cholinergic properties, to reduce POUR after IHR, yet none have focused on an exclusively laparoscopic cohort.</p> Methods <p>This retrospective cohort study included adult male patients who underwent elective laparoscopic IHR procedures performed by a single surgeon from October 2021 to June 2024. Patients were divided into two groups: neostigmine/glycopyrrolate (NG-G) vs. sugammadex (SG). POUR rates and secondary outcomes were compared.</p> Results <p>Of the total <i>n</i> = 228 patients, NG-G included <i>n</i> = 122 and SG <i>n</i> = 106. Median age was 61.6&#xa0;years. Procedures were predominantly totally extraperitoneal (92.5%). Age, prostate disease history, International Prostate Symptom Scores, anesthesia/operative times, intraoperative/PACU opioid use, steroid use, and anticholinergic use were similar between groups (<i>p</i> &gt; 0.05). NG-G patients received more intravenous fluids, but still &lt; 500&#xa0;mL (375 vs. 250&#xa0;mL, <i>p</i> &lt; 0.01). Twelve patients (9.8%) in the NG-G cohort experienced POUR versus none in SG (<i>p</i> &lt; 0.01). Urinary symptoms were reported in 19.7% of NG-G cases and 0% of SG (<i>p</i> &lt; 0.01). Post-void residual volumes were lower in the SG group (median 9 vs 136&#xa0;mL, <i>p</i> &lt; 0.01). The SG cohort had shorter recovery times (191.5 vs 306.0&#xa0;min, <i>p</i> &lt; 0.01). There were 2 readmissions for NG-G cases, both for urinary retention, and none in SG (<i>p</i> = 0.19).</p> Conclusions <p>Patients who received sugammadex compared to neostigmine/glycopyrrolate had lower rates of POUR and shorter recovery times, suggesting that sugammadex should be the routine reversal agent in laparoscopic IHR, especially in older men with prostate disease at increased risk of retention.</p> Graphical Abstract <p></p>

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Sugammadex reduces urinary retention after laparoscopic inguinal hernia repair: a retrospective analysis and brief literature review

  • 期刊论文

  • 发表日期：

    2025年7月1日

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  • Alexandra Z. Agathis,
  • Jeanne Wu,
  • Elisha Dickstein,
  • Damien J. Lazar,
  • Linda P. Zhang,
  • Scott Q. Nguyen,
  • Edward H. Chin

摘要

Introduction

Postoperative urinary retention (POUR) is common after inguinal hernia repairs (IHR). General anesthesia often utilizes paralytic agents such as vecuronium and rocuronium, which are subsequently reversed with neostigmine upon surgery completion. Neostigmine has undesired cholinergic effects, however, and is typically co-administered with glycopyrrolate, an anticholinergic agent which can impair bladder contraction, leading to urinary retention. Early studies have investigated sugammadex, an alternative reversal agent without cholinergic properties, to reduce POUR after IHR, yet none have focused on an exclusively laparoscopic cohort.

Methods

This retrospective cohort study included adult male patients who underwent elective laparoscopic IHR procedures performed by a single surgeon from October 2021 to June 2024. Patients were divided into two groups: neostigmine/glycopyrrolate (NG-G) vs. sugammadex (SG). POUR rates and secondary outcomes were compared.

Results

Of the total n = 228 patients, NG-G included n = 122 and SG n = 106. Median age was 61.6 years. Procedures were predominantly totally extraperitoneal (92.5%). Age, prostate disease history, International Prostate Symptom Scores, anesthesia/operative times, intraoperative/PACU opioid use, steroid use, and anticholinergic use were similar between groups (p > 0.05). NG-G patients received more intravenous fluids, but still < 500 mL (375 vs. 250 mL, p < 0.01). Twelve patients (9.8%) in the NG-G cohort experienced POUR versus none in SG (p < 0.01). Urinary symptoms were reported in 19.7% of NG-G cases and 0% of SG (p < 0.01). Post-void residual volumes were lower in the SG group (median 9 vs 136 mL, p < 0.01). The SG cohort had shorter recovery times (191.5 vs 306.0 min, p < 0.01). There were 2 readmissions for NG-G cases, both for urinary retention, and none in SG (p = 0.19).

Conclusions

Patients who received sugammadex compared to neostigmine/glycopyrrolate had lower rates of POUR and shorter recovery times, suggesting that sugammadex should be the routine reversal agent in laparoscopic IHR, especially in older men with prostate disease at increased risk of retention.

Graphical Abstract