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The Impact of Phenazopyridine on Postoperative Pain and Voiding Trial Success

The Impact of Phenazopyridine on Postoperative Pain and Voiding Trial Success

Presenting Author(s)

Alyssa N. Sheedy, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Clarence, New York, United States

Co-Author(s)

Salma Attai, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Buffalo, New York, United States
JL

Ji Young Lee, MD, MPH

Obstetrician & Gynecologist
Sisters of Charity Hospital, Catholic Health
Buffalo, New York, United States
EA

Ekhlas Abdulraheem, MBBCh (she/her/hers)

PGY-3 OBGYN Resident
Catholic Health, Sisters of Charity Hospital
Buffalo, New York, United States
AE

Abeer Eddib, MD

Urogynecologist
Kaleida Health
Getzville, New York, United States

Objectives: Phenazopyridine exerts local analgesic effects on urinary tract mucosa through an unknown mechanism. Previous studies demonstrated the favorable effect of preoperative phenazopyridine in the prevention of urinary retention following urogynecological surgeries. The goal of this study is to investigate the impact of preoperative administration of phenazopyridine on postoperative pain and voiding trial success after sacrocolpepexy procedures.

Methods:

Design: Retrospective case-control study

Setting: Academic-affiliated community hospital

Participants: All patients (N=1260) undergoing robotic sacrocolpopexy by a single urogynecologist at a single institution between January 2012 and March 2023 were evaluated for the impact of preoperative phenazopyridine use on postoperative pain and the success of voiding trials. Phenazopyridine was used to aid in visualization of the ureter at the time of cystoscopy.

Interventions: Patients were divided into two groups depending on whether or not they received phenazopyridine before surgery. Cases (n=1118) who received preoperative phenazopyridine were compared to the controls (n=72) who did not receive phenazopyridine.

Results: Demographics of the participants in the case vs control groups were similar except the phenazopyridine group had slightly more obese patients with a mean BMI of 28.5 vs 27.1 in the non-phenazopyridine group with a p-value < 0.05. In terms of concomitant procedures, patients who received phenazopyridine were more likely to have a perineorrhaphy 896 (75.6%) vs 6 (8.82%) with p< 0.05, and were also more likely to have hysterectomy 748 (63%) vs 33 (45.8%) p< 0.05. The patients who received phenazopyridine also had longer procedure times 110[77;141] vs 87 [60;110] p< 0.05.

The primary outcome showed there is a statistically significant difference in the total pain MME (Morphine milligram equivalents) between both groups during postoperative hospital admission. The phenazopyridine group had a lower MME of 15 [4.00;26.5] vs 17 [9.62;30.5] in the non-phenazopyridine group, OR (odds ratio) 0.99 [0.97;1.00] p=0.04. The secondary outcome of voiding trial success showed that the phenazopyridine group also had more failed postoperative voiding trials 487(41.0%) vs 12 (16.7%) OR 3.77 [2.03;7.59] p< 0.05.

Conclusions: Although the mechanism is unknown, the use of preoperative phenazopyridine prior to SCP surgery is associated with less postoperative total pain MME with a significant statistical difference. The use of phenazopyridine is also associated with more significant failure in postoperative voiding trials. Further studies are necessary to understand the effects of phenazopyridine on postoperative voiding trials.