POSTOPERATIVE urinary retention is a common and costly complication following minimally invasive inguinal hernia repair (MIS-IHR). Rates of postoperative urinary retention vary widely, from 0.4%–41.6%, and it can lead to increased morbidity, longer hospital stays, and decreased patient satisfaction. Recent studies have highlighted the financial burden of postoperative urinary retention, with mean charges reaching 9,418USD for inpatient care and 1,694USD for outpatient management.
Sugammadex as a Solution for Postoperative Urinary Retention
Several risk factors increase the likelihood of postoperative urinary retention, including general or opioid-based anaesthesia, bilateral hernia repair, high-volume fluid administration, and underlying benign prostatic hyperplasia (BPH). Traditional neuromuscular blockade reversal agents, which often rely on anticholinergic medications, have also been identified as independent contributors to postoperative urinary retention.
Sugammadex, a newer neuromuscular blockade reversal agent, has shown promise in mitigating these risks. In a recent prospective study, patients receiving sugammadex during MIS-IHR experienced a significant reduction in postoperative urinary retention and length of stay (LOS). Notably, no patient in the sugammadex group developed postoperative urinary retention, even when multiple risk factors were present. This suggests that sugammadex may offer both clinical and operational benefits in hernia surgery.
Benefits Beyond Urinary Retention
The advantages of sugammadex extend beyond postoperative urinary retention prevention. By reducing complications, it can decrease prolonged PACU stays, inpatient admissions, urology consultations, and follow-up visits, ultimately reducing healthcare costs. Moreover, sugammadex has been associated with lower rates of postoperative respiratory compromise compared with traditional reversal agents like neostigmine, while avoiding the adverse effects of anticholinergic medications.
Despite limitations such as small sample sizes and incomplete data on bladder volumes and fluid administration, the findings support considering sugammadex for high-risk MIS-IHR patients. Its use may not only improve patient outcomes and satisfaction but also enhance resource utilisation and potentially offer cost savings for healthcare systems.
Integrating sugammadex into routine practice for minimally invasive inguinal hernia repair could therefore represent an important step in reducing postoperative urinary retention incidence and improving perioperative care quality.
Reference
Lorenz WR et al. Sugammadex for postoperative urinary retention in minimally invasive inguinal hernia repair: a nonrandomized clinical trial. JAMA Netw Open. 2025;8(10):e2536944.
