A systematic review and meta-analysis of neostigmine for urinary retention after surgeries

Background: The aim of this research is to analyze the efficacy of neostigmine in the treatment of postoperative urinary retention (POUR). Methods: In this research, we screened multiple databases including PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI). After a systematic search process, data extraction was conducted. Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis, and bias analysis. Results: After searching for articles, 20 eligible trials including 1,850 patients after surgery were extracted. Our results suggested that the neostigmine group had a higher effective rate for urinary retention than the Chinese traditional and physical therapy group (OR=7.47, 95% CI: 4.10-13.59, overall effect P<0.001). Further subgroup analysis showed that neostigmine acupoint injection was better than neostigmine intramuscular injection. Time to first voiding in the neostigmine acupoint injection group was shorter than that in the neostigmine intramuscular injection group (MD=-81.92, 95% CI: -130.13 to -33.70, overall P<0.001, I-2=99% with random effects model). Furthermore, neostigmine acupoint injection improved urine excretion (MD=243.40, 95% CI: 201.62-285.18, overall P<0.0001) and reduced the residual urine volume (MD=-41.31, 95% CI: -58.05 to -24.58, overall P<0.001, I-2=75% with random effects model). The results of the sensitivity analysis and publication bias showed that this research was robust and had little publication bias. Discussion: Our meta-analysis results suggest that neostigmine can effectively improve the symptoms of POUR and neostigmine acupoint injection may achieve a better therapeutic effect.