We would like to contribute to the recent critique responding to our article titled “The effect of atropine in preventing catheter-related pain and discomfort in patients undergoing transurethral resection due to bladder tumor: a prospective, randomized, controlled study” [1]. First, we also would like to thank our colleagues for their valuable contributions.

Traditionally, the therapeutic effects and side effects of medications in clinical use are very well known. However, unexpected adverse effects are also a possibility, even for drugs known to be “the safest”. Some new medicines introduced into clinical use have also been discontinued due to their unanticipated side effects. Atropine, however, is not a recently developed medication, and it has been routinely used in practical anesthesia for decades [2].

With its muscarinic effects, atropine has long been used in clinical practice [2]. Currently, the use of atropine as premedication has been abandoned due to its effects on the central nervous system. In our study, atropine was also intraoperatively administered, and no patient received it outside the operating room [1]. Thus, we did not observe any side effects. As we stated in the materials and methods section, all participating patients were examined preoperatively, and their clinical cardiac statuses were evaluated, and the patients with previously known or symptomatic heart failure and arrhythmia were excluded [1].

For this reason, no side effects were observed in any patient, postoperatively, either. As we mentioned in our study, high risk-group medications, such as atropine, must be administered only in risk-free conditions where emergency personnel and equipment i.e. anesthesiologists and anesthetists are available, and patients are monitored in the operating room [1].

We absolutely considered a probable urinary retention effect from atropine during the planning stage, before starting the study. In our clinic, patients receive urinary catheters for a minimum of 72 hours during the postoperative period after the transurethral resection of bladder tumor surgeries. Thus, our study consisted of only patients with urologic diseases. Most patients receive a urinary catheter and the following sense of irritation adversely affect the patient comfort during the post-operative period [3,4]. We remarked on this issue thoroughly in our article.

The effect of atropine will last up to post-operative 6 hour, maximally [2]. Thus, in the planning phase of our study, we planned a 24-hour pain follow-up for this sort acting drug. We did not continue the follow-ups since we had concluded that pain follow-ups in the post-operative 2nd and 3rd days, when the effects of atropine and sugammadex had already worn off, would not provide any help to the aim of the study. During the post-op 24 hours, no severe catheter-related bladder discomfort (CRBD) had been observed in either group in the patients’ CRBD follow-ups. In the article, incidence and severity of CRBD in patients are given in detail [1].

We appreciate your interest and valuable comments on our article.