OBJECTIVE: This study aimed to examine how anticholinergic medication exposure affects the risk of failed postoperative void trial (VT) in women undergoing urogynecologic surgery. METHODS: We conducted a retrospective cohort study of women undergoing outpatient prolapse or incontinence surgery. We evaluated perioperative anticholinergic exposure via the validated anticholinergic risk scale (ARS). Total ARS score was calculated by summing the individual ARS for each medication used during the following periods: at home before surgery, in preoperative holding, intraoperatively, and in postoperative recovery. The "low anticholinergic exposure" cohort (total ARS, ≤7) was compared to the "high anticholinergic exposure" cohort (total ARS, ≥8) to assess our primary outcome: failed postoperative VT on day of surgery. RESULTS: Of 125 women in the study, 98 (78%) had low anticholinergic exposure and 27 (22%) had high anticholinergic exposure. Overall, 28 (22%) patients failed the postoperative VT. Women in the high anticholinergic group had a significantly higher risk of a failed VT (41% vs 17%, P = 0.01 for high vs low anticholinergic groups, respectively). In logistic regression analysis, adjusting for age, body mass index, diabetes, midurethral sling and anterior repair, high anticholinergic exposure (AOR, 4.15; 95% confidence interval, 1.49-11.57), and anterior repair (AOR, 3.15; 95% CI, 1.15-8.61) remained significantly associated with failed postoperative VT. CONCLUSIONS: Higher exposure to perioperative anticholinergic medications increases the risk of a failed postoperative VT after outpatient urogynecologic surgery.