Incidence of Urinary Retention with Glycopyrrolate at Normal Dosages
Urinary retention occurs in approximately 15% of patients receiving glycopyrrolate during anesthesia, with rates varying from 1.75% to 9.8% depending on the surgical context and patient population. 1, 2
FDA-Labeled Incidence
The FDA drug label for glycopyrrolate oral solution reports that urinary retention occurred in 15% of patients (3 out of 20) in placebo-controlled trials, compared to 0% in the placebo group. 1 This represents the official prescribing information for the medication at normal therapeutic dosages.
Surgical Context Data
The incidence varies significantly based on clinical setting:
General ambulatory surgery: 4.2% overall incidence of postoperative urinary retention (POUR) in patients undergoing day-case general surgery, with glycopyrrolate administration independently associated with a 3.48-fold increased risk (OR 3.48, p=0.037). 2
Midurethral sling procedures: Only 3.51% of patients receiving glycopyrrolate experienced acute temporary urinary retention, which was not statistically different from those who did not receive it (6.41%, p=0.70). 3 When excluding persistent voiding dysfunction beyond 48 hours, the rate dropped to just 1.75%. 3
Spinal fusion surgery: Glycopyrrolate use was independently associated with a 2.60-fold increased risk of POUR (OR 2.60, p=0.001). 4
Laparoscopic inguinal hernia repair: 9.8% of patients receiving neostigmine/glycopyrrolate experienced POUR versus 0% with sugammadex (alternative reversal agent), representing a statistically significant difference (p<0.01). 5
High-Risk Populations
Older adults face substantially elevated risk, particularly those aged 56 years or older, who have an 8.14-fold increased risk of POUR when combined with glycopyrrolate use (OR 8.14, p=0.0018). 2 The combination of advanced age and glycopyrrolate administration creates a synergistic risk profile.
Patients with pre-existing urinary tract conditions are at markedly higher risk:
- Those with benign prostatic hyperplasia have a 3.34-fold increased risk of POUR (OR 3.34, p≤0.001). 4
- The American Geriatrics Society notes that elderly patients with compromised autonomic function, including diabetic autonomic insufficiency, face substantially elevated risk. 6
Mechanism and Clinical Implications
Glycopyrrolate's anticholinergic properties cause urinary retention through inhibition of bladder contraction and increased sphincter tone. 1, 7 The FDA label specifically warns about this effect under anticholinergic drug effects, noting that the medication should be used with caution in patients with autonomic neuropathy and renal disease. 1
Common pitfall: Male sex and lower urinary tract symptoms alone were not independently significant risk factors in multivariate analysis, contrary to common clinical assumptions. 2 The critical modifiable risk factor is glycopyrrolate administration itself, particularly in patients over 56 years of age.
Practical Considerations
The risk appears dose-dependent and timing-dependent, being most common during early treatment courses. 6 In laparoscopic procedures where glycopyrrolate is frequently administered, alternative reversal agents like sugammadex eliminate POUR risk entirely (0% vs 9.8%, p<0.01). 5
Monitor patients closely within the first 4-5 days of glycopyrrolate initiation or after dose increases, as constipation and urinary retention are dose-limiting adverse reactions that may require discontinuation. 1