1578 URETHRAL SPHINCTER FUNCTION IN WOMEN DURING THORACIC EPIDURALLY ANALGESIA: A POOLED ANALYSIS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology (I)1 Apr 20131578 URETHRAL SPHINCTER FUNCTION IN WOMEN DURING THORACIC EPIDURALLY ANALGESIA: A POOLED ANALYSIS Livio Mordasini, Tobias Metzger, Thomas M. Kessler, Fiona C. Burkhard, and Patrick Y. Wuethrich Livio MordasiniLivio Mordasini Bern, Switzerland More articles by this author , Tobias MetzgerTobias Metzger Bern, Switzerland More articles by this author , Thomas M. KesslerThomas M. Kessler Zuerich, Switzerland More articles by this author , Fiona C. BurkhardFiona C. Burkhard Bern, Switzerland More articles by this author , and Patrick Y. WuethrichPatrick Y. Wuethrich Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in relevant postvoid residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is still unknown. METHODS The present study is a pooled analysis of an open observational study and a double-blind randomized trial. Twenty-eight women without lower urinary tract symptoms, who underwent open renal surgery with TEA, were pooled and categorized into three groups with different epidural mixtures (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/ml and 13 with bupivacaine 0.1% plus fentanyl 2 μg/ml and epinephrine 2 μg/ml). All women underwent urethral pressure measurements at rest before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9. RESULTS Maximum urethral closure pressure (MUCP) at rest decreased significantly during TEA with bupivacaine alone (median 70 cmH2O [range: 60-80] to 43 [19-68], P=0.031) and with bupivacaine/fentanyl/epinephrine (75 cmH2O [range: 33-115] to 56 [24-105], P=0.028), whereas with bupivacaine/fentanyl no significant change could be detected (74 [49-95] vs 67 [38-86], P=0.156). In all groups functional profile length at rest was not influenced during TEA. CONCLUSIONS TEA with bupivacaine decrease MUCP at rest in women. The addition of fentanyl counteracts this effect. If epinephrine, which reduces the fentanyl plasma concentration by half is also added, MUCP is again significantly decreased. The effect of fentanyl is most likely systemic. The observed increase of MUCP may further explain the negative effect of systemic opiods on voiding function. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e648 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Livio Mordasini Bern, Switzerland More articles by this author Tobias Metzger Bern, Switzerland More articles by this author Thomas M. Kessler Zuerich, Switzerland More articles by this author Fiona C. Burkhard Bern, Switzerland More articles by this author Patrick Y. Wuethrich Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...