Effect of Scopolamine Patch Use on Postoperative Voiding Function After Transobturator Slings.

OBJECTIVES: The aim of this study was to determine whether the use of a preoperative transdermal scopolamine (TDS) patch for postoperative nausea and vomiting prophylaxis affects the success of a voiding trial after a transobturator tape sling procedure. METHODS: This study is a retrospective cohort study of adult women who underwent a transobturator tape sling procedure without concomitant procedures from February 1, 2009 through August 1, 2010. The exposed group included all eligible women who received a preoperative TDS patch. For each exposed woman, we selected the next 2 consecutive eligible women who did not receive a TDS patch to be included in the unexposed group. The primary outcome was postoperative voiding trial failure. RESULTS: We identified 35 women who met eligibility criteria and used a preoperative TDS patch, and included 70 women who did not use a preoperative TDS. A significantly higher proportion of women in the TDS patch group (54.3%) failed their voiding trial than in the group that did not receive TDS (7.1%, P ≤ 0.001). A history of an incontinence procedure, older age, and higher body mass index strengthened the association between TDS patch and voiding trial failure. The adjusted model yielded a risk ratio for voiding trial failure of 13.8 (95% confidence interval, 5.2-36.5) for women who received TDS patch compared with those who did not. CONCLUSIONS: The results of this study demonstrate that use of TDS patches for postoperative nausea and vomiting prophylaxis may negatively affect the success of voiding trials after transobturator tape sling procedures.

The effect of body mass index on the outcomes of first assisted reproductive technology cycles.

OBJECTIVE: To provide assisted reproductive technology (ART) outcome rates per body mass index (BMI) category after controlling for potential confounders. DESIGN: Retrospective cohort study. SETTING: Large university-affiliated infertility practice. PATIENT(S): Women undergoing ART. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The primary outcome was live birth. Analyses were stratified according to BMI category and adjusted for potential confounders, including maternal and paternal age, baseline serum FSH, duration of gonadotropin stimulation, mean daily gonadotropin dose, peak serum E(2), number of oocytes retrieved, use of intracytoplasmic sperm injection, embryo quality and number, transfer day, and number of embryos transferred. RESULT(S): We analyzed the first autologous fresh IVF or IVF-ICSI cycle of 4,609 patients. There were no differences in the rates of cycle cancellation, spontaneous abortion, biochemical and ectopic pregnancies, or multiple births. After adjusting for potential confounders, patients with BMI ≥ 30.0 kg/m(2) had significantly decreased odds of implantation, clinical pregnancy, and live birth. The adjusted odds ratio (95% confidence interval [CI]) of live birth were 0.63 (0.47-0.85) for BMI 30.00-34.99, 0.39 (0.25-0.61) for BMI 35.00-39.99, and 0.32 (0.16-0.64) for BMI ≥ 40.0 compared with normal-weight cohorts. CONCLUSION(S): Obesity has a significant negative effect on ART outcomes. Patients with BMI > 30 kg/m(2) have up to 68% lower odds of having a live birth following their first ART cycle compared with women with BMI < 30.