Postoperative urinary retention after pelvic organ prolapse surgery: influence of peri-operative factors and trial of void protocol

Abstract Purpose Transient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively. Methods We conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015 to October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to “pass” the protocol. Results Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension. A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI1.6–2.9) and 2.3 (95% CI 1.8–3.1) times more likely to have elevated PVR after their second TOV and third TOV (p < 0.0001), respectively, compared with those without concomitant MUS. Permitting a third TOV allowed an additional 10% of women to pass the voiding protocol before discharge. The median number of voids to pass protocol was 2. An ASA > 2 and placement of MUS were associated with increasing number of voids needed to pass protocol. Conclusions While many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations.

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Postoperative Urinary Retention after Pelvic Organ Prolapse Surgery – Influence of Peri-operative Factors and Trial of Void Protocol

10.21203/rs.3.rs-137030/v1 ◽

2021 ◽

Author(s):

Breffini Anglim ◽

Kaylee Ramage ◽

Emily Sandwith ◽

Erin Brennand

Keyword(s):

Pelvic Floor ◽

Urinary Retention ◽

Significant Risk ◽

Median Number ◽

Pelvic Organ ◽

Anterior Repair ◽

Tertiary Referral Centre ◽

Postoperative Urinary Retention ◽

Pelvic Floor Surgery ◽

Pop Surgery

Abstract PurposeTransient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively. MethodsWe conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015-October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to “pass” the protocol. Results Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension.A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI:1.6-2.9) and 2.3 (95% CI:1.8-3.1) times more likely to have elevated PVR after their second TOV and third TOV (P<0.0001), respectively, compared with those without concomitant MUS. Permitting a third TOV allowed an additional 10% of women to pass the voiding protocol before discharge. The median number of voids to pass protocol was 2. An ASA>2 and placement of MUS were associated with increasing number of voids needed to pass protocol. ConclusionsWhile many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations.

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Incidence of postoperative urinary retention after pelvic organ prolapse surgery in Cipto Mangunkusumo National General Hospital

Medical Journal of Indonesia ◽

10.13181/mji.v23i4.1086 ◽

2015 ◽

Vol 23 (4) ◽

pp. 218-22

Author(s):

Tyas Priyatini ◽

Joan M. Sari

Keyword(s):

Pelvic Organ Prolapse ◽

Urinary Retention ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Operative Blood Loss ◽

Postoperative Urinary Retention ◽

Pelvic Organ Prolapse Surgery ◽

Pelvic Prolapse ◽

Pop Surgery ◽

Duration Of Surgery

Background: After vaginal delivery, every woman has 50% risk for pelvic organ prolapse (POP). The lifetime risk for a woman to undergo surgical treatment for POP was 11%, with the incidence of postoperative urinary retention (POUR) after POP surgery of 2%-43%. The aim of our study is to identify the incidence of POUR after POP surgery in Cipto Mangunkusumo National General Hospital (RSCM) and the risk factors.Methods: Medical records of 124 women undergoing pelvic prolapse surgery between 2010 and 2013 were analyzed. The incidence of POUR and the risk factors were identified by performing univariate and bivariate analysis using chi-Square test and its alternative with using SPSS 20.0. Independent variables include age, body mass index (BMI), parity, degree of prolapse, type of surgery technique, type of anesthesia, type of suture material, amount of intra-operative blood loss, and duration of surgery. POUR defined as urine residual volume more than 100cc.Results: The incidence of urinary retention after pelvic prolapse surgery was 29%. There was no correlation between age, BMI, parity, degree of prolapse, type of surgery technique, anesthesia, suture, intra-operative blood loss, duration of surgery, and the occurrence of urinary retention after pelvic organ prolapse surgery.Conclusion: The incidence of urinary retention after pelvic organ prolapse surgery was 29%. There was no correlation between the risk factors and the occurrence of urinary retention after pelvic organ prolapse surgery.

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Anesthetics' role in postoperative urinary retention after pelvic organ prolapse surgery with concomitant midurethral slings: a randomized clinical trial

International Urogynecology Journal ◽

10.1007/s00192-019-03917-w ◽

2019 ◽

Vol 31 (1) ◽

pp. 205-213

Author(s):

Alexandriah Alas ◽

Laura Martin ◽

Hemikaa Devakumar ◽

Lawrence Frank ◽

Sneha Vaish ◽

...

Keyword(s):

Clinical Trial ◽

Pelvic Organ Prolapse ◽

Randomized Clinical Trial ◽

Urinary Retention ◽

Pelvic Organ ◽

Prolapse Surgery ◽

Midurethral Slings ◽

Postoperative Urinary Retention ◽

Pelvic Organ Prolapse Surgery

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A Risk Calculator for Post-Operative Urinary Retention (POUR) Following Vaginal Pelvic Floor Surgery: Multivariable Prediction Modelling

10.22541/au.164141839.98899108/v1 ◽

2022 ◽

Author(s):

Breffini Anglim ◽

George Tomlinson ◽

Joalee Paquette ◽

Colleen McDermott

Keyword(s):

Pelvic Floor ◽

Urinary Retention ◽

Pelvic Surgery ◽

Risk Calculator ◽

Management Options ◽

Data Set ◽

Pelvic Floor Surgery ◽

Estimated Blood Loss ◽

Increased Risk ◽

Prediction Modelling

Objective: To determine the peri-operative characteristics associated with an increased risk of post-operative urinary retention (POUR) following vaginal pelvic floor surgery. Design: A retrospective cohort study using multivariable prediction modelling. Setting: A tertiary referral urogynaecology unit. Population: Patients undergoing vaginal pelvic floor surgery from January 2015 to February 2020. Methods: Eighteen variables (24 parameters) were compared between those with and without POUR and then included as potential predictors in statistical models to predict POUR. The final model was chosen as the one with the largest c-index from internal cross-validation. This was then externally validated using a separate data set (n=94) from another surgical centre. Main Outcome Measures: diagnosis of POUR following surgery while the patient was in hospital. Results: Among the 700 women undergoing surgery, 301 (43%) experienced POUR. Pre-operative variables with statistically significant univariate relationships with POUR included age, menopausal status, prolapse stage, and uroflow parameters. Significant peri-operative factors included estimated blood loss, amount of intravenous fluid administered, operative time, length of stay, and specific procedures including vaginal hysterectomy with intraperitoneal vault suspension, anterior colporrhaphy, posterior colporrhaphy, and colpocleisis. The lasso logistic regression model had the best combination of internally cross-validated c-index (0.73) and accurate calibration curve. Using this data, a POUR risk calculator was developed (https://pourrisk.shinyapps.io/POUR/). Conclusions: This POUR risk calculator will allow physicians to counsel patients pre-operatively on their risk of developing POUR after vaginal pelvic surgery and help focus discussion around potential management options.

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Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach

Neurourology and Urodynamics ◽

10.1002/nau.23526 ◽

2018 ◽

Vol 37 (5) ◽

pp. 1794-1800 ◽

Cited By ~ 5

Author(s):

Junchan J. Yune ◽

Julie W. Cheng ◽

Hillary Wagner ◽

Joo Kim ◽

Jeffrey S. Hardesty ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Urinary Retention ◽

Pelvic Organ ◽

Prolapse Repair ◽

Postoperative Urinary Retention ◽

Transabdominal Approach ◽

Pelvic Organ Prolapse Repair

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Preoperative Tamsulosin to Prevent Postoperative Urinary Retention After Surgery For Pelvic Floor Disorders

Case Medical Research ◽

10.31525/ct1-nct04232683 ◽

2020 ◽

Author(s):

Keyword(s):

Pelvic Floor ◽

Urinary Retention ◽

Pelvic Floor Disorders ◽

Postoperative Urinary Retention

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Uterus Preservation in Case of Vaginal Prolapse Surgery Acts as a Protector against Postoperative Urinary Retention

Journal of Clinical Medicine ◽

10.3390/jcm9113773 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3773

Author(s):

Christine Bekos ◽

Raffaela Morgenbesser ◽

Heinz Kölbl ◽

Heinrich Husslein ◽

Wolfgang Umek ◽

...

Keyword(s):

Risk Factors ◽

Urinary Retention ◽

Multiple Logistic Regression Analysis ◽

Urine Volume ◽

Pelvic Organ ◽

Vaginal Prolapse ◽

Prolapse Surgery ◽

Postoperative Urinary Retention ◽

Vaginal Prolapse Surgery ◽

Uterus Preservation

Background: The aim of this study was to identify clinical risk factors for increased post-void residual (PVR) volumes in patients undergoing vaginal prolapse surgery and to find out whether uterus preservation or prolapse hysterectomy influences the incidence of postoperative urinary retention. Methods: This retrospective study included women who presented with pelvic organ prolapse (POP) and planned prolapse surgery between January 2017 and July 2019. PVR was assessed postoperatively and increased amounts were defined as incomplete voiding with residual urine volume greater than 150 mL. Results: Increased PVR at the first postoperative day occurred in 31.8% (56/176). Body mass index (BMI) was significantly lower in patients with increased PVR after pelvic floor surgery compared to patients with normal PVR amounts (p = 0.040). Furthermore, during multiple logistic regression analysis, low BMI (p = 0.009) as well as prolapse hysterectomy (p = 0.032) turned out to be the strongest risk factors associated with increased PVR volume. Conclusion: This is the first study identifying prolapse hysterectomy as an independent risk factor for increased PVR after surgical prolapse repair. Our results might be helpful in counseling patients prior to surgery and underline the option of uterus preservation during prolapse surgery in selected cases.

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