Table 1.
Characteristics of Included Studies and the Main Outcomes of Included Studies
| Study | Design | Participants | Interventions | Incidence of CRBDa | Severity of CRBDa | Other outcomea | Adverse effectsa |
|---|---|---|---|---|---|---|---|
| Muscarinic antagonists | |||||||
| Zhang et al.5 | Randomized, prospective single-blind | 116 patients with nonmuscle-invasive bladder cancer undergoing TURBT | G1: solifenacin 5 mg, 6 h before surgery and after surgery 5 mg/day for 2 weeks, po (n=58) | 6 h: 67.2% vs 93.1% 12 h: 62.1% vs 82.8% 24 h: 56.9% vs 79.3% 48 h: 48.3% vs 62.1% 72 h: 32.8% vs 48.3% (p<0.05) |
The severity of CRBD (mild, moderate, severe) was significantly reduced in group 1 compared with group 2 (p=0.008) | Overactive bladder symptom scores: 5.67 vs 7.86 (p<.001) | Dry mouth: 10.3% vs 6.9% (p=0.743) Constipation:8.6% vs 3.4% (p=0.438) Headache:1.7% vs 0 (p=1.0) Dizziness:1.7% vs 0 (p=1.0) |
| G2: placebo (n=58) | |||||||
| Ryu et al.6 | Randomized, prospective double-blind | 57 male patients with CRBD after elective urologic surgery for the upper urinary tract or robotic retropubic radical prostatectomy | G1: butylscopolamine 20 mg/iv (n=28) | — | 1 h: 59 (12) vs 41 (22) 2 h: 50 (16) vs 32 (25) 6 h: 40 (21) vs 23 (18) (p=0.01)b |
Rescue analgesics (<0.01) None: 24% vs 54% Once: 48% vs 46% Twice: 28% vs 0 |
Dry mouth: 93% vs 93% (p>0.99) PONV: one in each group |
| G2: normal saline 1 mL/iv (n=29) | |||||||
| Nam et al.15 | Randomized, prospective double-blind | 99 patients undergoing nonurologic surgeries | G1: butylscopolamine 20 mg/iv (n=49) | Overall: 31% vs 66% 1 h: 27% vs 54% 2 h: 22% vs 42% 6 h: 10% vs 26% (p<0.05) |
First 6 h postoperatively was less in the butylscopolamine group than the control group (median [interquartile range], 0 [0–17] vs 22 [0–47], respectively; p=0.002) | Rescue analgesics: 2% vs 8% (p=0.362) | Dry mouth: 86% vs 94% (p=0.20) PONV: 4% vs 14% (p=0.16) |
| G2: placebo (n=50) | |||||||
| Tauzin-Fin et al.7 | Randomized, prospective double-blind | 46 men undergoing radical retropubic prostatectomy | G1: oxybutynin 5 mg/po, every 8 h during the 24 h after surgery (n=23) | 17% vs 65% (p<0.01) | Cumulative tramadol consumption (mg) [mean (SD)]: 146 (48) vs 322.9 (124.3) (p<0.01) Patient satisfaction scorec: 8 (7–9) vs 5 (4–5) (p<0.001) |
No patient in group oxybutynin reported a dry mouth | |
| G2: placebo, po (n=23) | |||||||
| Agarwal et al.8 | Randomized, prospective double-blind | 234 patients undergoing elective PCNL surgery for renal and upper ureteral stone | G1: oxybutynin 5 mg/po (n=78) | 35% vs 33% vs 58% (p<0.05) | Significant reduction was observed after oxybutynin and tolterodine therapy compared with control (p<0.05) | There were no differences in fentanyl consumption between the groups | Dry mouth (p<0.05) 0 h:51.3% vs 46.2% vs 19.2% 1 h: 59% vs 55.1% vs 24.4% |
| G2: tolterodine 2 mg/po (n=78) | |||||||
| G3: placebo, po (n=78) | |||||||
| Agarwal et al.1 | Randomized, prospective double-blind | 215 patients undergoing elective endoscopic or open urologic surgery for the kidney and ureter | G1: tolterodine 2 mg/po, 1 h before induction of anesthesia (n=50) | 0 h: 17% vs 82% 1 h: 18% vs 91% 2 h: 15% vs 83% 6 h: 10% vs 60% (p<0.05) |
— | — | Dry mouth 0 h: 54% vs 22% (p<0.05) 1 h: 66% vs 47% (p<0.05) There were no differences at 2 and 6 h |
| G2: placebo, po (n=165) | |||||||
| Anesthetics | |||||||
| Shariat et al.9 | Randomized, prospective double-blind | 114 patients undergoing an elective nephrectomy | G1: ketamine 0.5 mg/kg/iv after induction of anesthesia, but before urinary catheterization (n=57) | At 0 and 1 h in recovery: 38.6% (22/57), 22.8% (13/57) vs 68.4% (39/57), 57.9% (33/57), respectively (p<0.001) | At 2 and 6 h, the incidence and severity were not significantly different between the two groups (p>0.05) | — | Sedation: at 0 h:12% vs 0 (p<0.05) A decreased incidence of PONV was observed at 2- and 6-h visits in the intervention group |
| G2: normal saline 2 mL/iv (n=57) | |||||||
| Safavi et al.10 | Randomized, prospective double-blind | 120 patients undergoing urological surgery who complained of CRBD in the recovery room | G1: ketamine 150 μg/kg/iv (n=30) | — | Significantly less in G2 and 3 compared with G1 and 4 till 24 h after operation (p<0.05) | Rescue analgesic consumption: significantly less in G2 and 3 compared with G1 and 4 (p<0.05). No significant difference was noted between G2 and 3 (p>0.05) | Sedation: lower in 15 min and 30 min in recovery in G2 and 3 compared with G4 and 1 (p<0.05) There was no significant difference between G2 and 3 (p>0.05) |
| G2: ketamine 200 μg/kg/iv (n=30) | |||||||
| G3: ketamine 250 μg/kg/iv (n=30) | There was no significant difference between G2 and 3 (p>0.05) | ||||||
| G4: normal saline, 2 mL/iv (n=30) | |||||||
| Agarwal et al.11 | Randomized, prospective double-blind | 54 patients undergoing elective PCNL for renal and upper ureteral stone and who spontaneously complained of CRBD, after operation | G1: ketamine 250 μg/kg/iv (n=27) | 2 h: 20% vs 92% 6 h: 19% vs 84% (p<0.05) |
Moderate (p<0.05) 1 h: 4% vs 64% |
— | Sedation (p<0.05) 1 h: 64% vs 4% 2 h: 92% vs 0 |
| G2: normal saline, 2 mL/iv (n=27) | |||||||
| Agarwal et al.12 | Randomized, prospective double-blind | 54 patients undergoing elective PCNL for renal and upper ureteral stone | G1: tramadol 1.5 mg/kg/iv (n=27) | 0 h: 28% vs 60% 1 h: 32% vs 64% 2 h: 28% vs 56% 6 h: 20% vs 48% (p<0.05) |
— | Postoperative fentanyl requirement (mg/kg): 210 (34.6) vs 176 (SD 26.5) (p<0.05) | Sedation: 60% (15/25) vs 16% (4/25) (p<0.05) Vomiting: 40% (10/25) vs 12% (3/25) (p<0.05) Nausea: 56% (14/25) vs 20% (5/25) (p<0.05) |
| G2: normal saline, 2 mL/iv (n=27) | |||||||
| Analgesics | |||||||
| Ergenoglu et al.13 | Randomized, prospective double-blind | 64 patients undergoing elective PCNL | G1: paracetamol 15 mg/kg/iv (n=32) | Postoperative (p<0.05) 0 h: 68.75% vs 87.5% 1 h: 62.5% vs 84.4% 2 h:59.4% vs 78.1% 4 h: 37.5% vs 78.1% 6 h: 28.2% vs 68.75% |
Moderate (p<0.05) 1 h: 21.9% vs 43.8% 2 h: 9.4% vs 43.8% 4 h: 3.1% vs 56.3% 6 h: 0 vs 37.5% |
Total consumption of meperidine: 52.72 [63.73] mg vs 75.81 [58.16] mg (p<0.05); Patient satisfaction scores: 4.53 (0.51) vs 3.84 (0.95) (p=0.002) | No patients required rescue analgesia |
| G2: normal saline, 1.5 mL/kg/iv (n=32) | |||||||
| Antiepileptics | |||||||
| Bala et al.4 | Randomized, prospective double-blind | 100 patients undergoing TURBT | G1: gabapentin 1200 mg/po (n=34) | Postoperative (p<0.05) 1 h: 0 vs 9% vs 66% 2 h: 26% vs 42% vs 90% 4 h: 18% vs 66% vs 87% 6 h: 9% vs 63% vs 87% 12 h: 0 vs 57% vs 87% 24 h: 0 vs 15% vs 84% |
1 h: Mild: 9% vs 0 vs 43.8% 2 h: Moderate: 0 vs 0 vs 43.8% 4 h: Mild: 61.8% (G1) vs 18.2% (G2), moderate: 3% vs 0 vs 39.4% 6, 12, 24 h: moderate: 3% vs 0 vs 45.5% |
The number needed to treat was 6 and 2 in G1 and G2, respectively | Blood pressure were comparable among groups Hypotension or bradycardia: None Dizziness: 1 vs 2 vs 0 (number) |
| G2: gabapentin 600 mg/po (n=33) | |||||||
| G3: placebo, po (n=33) | |||||||
| Agarwal et al.3 | Randomized, prospective double-blind | 108 patients undergoing elective PCNL for renal and upper ureteral stone | G1: gabapentin 600 mg/po (n=54) | The absolute risk reduction in G2 observed was 30% 0 h: 50% vs 80% 1 h: 61% vs 80% 2 h: 55% vs 76% 6 h: 37% vs 61% |
Mild: 0 h: 78% vs 21%, 6 h: 80% vs 39% Moderate: 1 h: 61% vs 30%, 6 h: 20% vs 57% Severe: 0 h: 0 vs 42%, 1 h: 0 vs 40%, 2 h: 3% vs 25% |
Number-needed-to-treat was 4 in G2. Requiring fentanyl (Number) (p<0.05): 0 h: 0 vs 7, 1 h: 3 vs 12, 2 h: 2 vs 10, 6 h: 1 vs 8 | There were no differences in postoperative sedation, PONV, feeling of light-headedness, or headache between the groups (p<0.05) |
| G2: placebo, po (n=54) | |||||||
| Srivastava et al.14 | Randomized, prospective double-blind | 60 patients undergoing elective spine surgery | G1: pregabalin 150 mg/po (n=30) | 0 h: 36.7% vs 70% 1 h: 36.7% vs 66.7% 2 h: 30% vs 60% 6 h: 16.7% vs 50% (p<0.05) |
Mild: 0 h: 23.3% vs 13.3%, 6 h: 13.3% vs 30% Moderate: 0 h: 13.3% vs 16.7%, 6 h: 3% vs 13% Severe: 0 h: 0 vs 40%, 2 h: 0 vs 20%, 6 h: 0% vs 6.7% |
Fentanyl requirements (ug): 211.83[43.54] vs 355.33[51.44] (p<0.05)b | Sedation score: 2.63 [0.67] vs 2.10 [0.61] (p=0.002); no significant differences in other side-effects between the two groups |
| G2: placebo, po (n=30) | |||||||
a
Interventions vs placebo.
b
Values are given as mean (SD) or number of patients (%).
c
Patient satisfaction score is given as values that are expressed as median (interquartile range).
CBRD, catheter-related bladder discomfort; G=group; OABSS=Overactive bladder symptom scores; PCNL=percutaneous nephrolithotomy; PONV=postoperative nausea and vomiting; TURBT=transurethral resection of bladder tumors.