Postpartum urinary retention: what are the sequelae? A long-term study and review of the literature

Abstract

Introduction and hypothesis Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed. Methods In our tertiary referral urogynecology unit in the University Women’s Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed. Results Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. Conclusions In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.

Enhancing bladder management for intrapartum/postpartum women at a maternity hospital in Taiwan: a best practice implementation project

“…11 If the increased postvoid residual urine volume is unresolved for more than seven days, it may lead to persistent voiding disorders. 12 The goal of bladder management during the intrapartum and postpartum periods, therefore, is to assess the patient for signs of bladder retention, detect any deviations from normal, and manage them in a timely manner to avoid complications of postpartum urinary dysfunction. 13 To date, there have been few evidence-based studies that deal with the optimization of care for perinatal bladder problems.…”

“…The Royal College of Nursing's bladder management guidelines recommend recording the timing and volume of the first void following birth and the times at which the indwelling urinary catheter was inserted and removed 11 . If the increased postvoid residual urine volume is unresolved for more than seven days, it may lead to persistent voiding disorders 12 . The goal of bladder management during the intrapartum and postpartum periods, therefore, is to assess the patient for signs of bladder retention, detect any deviations from normal, and manage them in a timely manner to avoid complications of postpartum urinary dysfunction 13 .…”

Current opinion: postpartum urinary disorders

“…Traumatic birth processes such as perineal edema, advanced lacerations and hematomas may cause mechanical bladder outlet obstruction [6]. Other sources of birth trauma may involve levator ani muscle avulsion and nerve injury involving the pelvic, hypogastric and pudendal nerves which can affect sensation and continence [3 ▪ ,8]. Obstetric anal sphincter injuries and other lacerations may also impair reflexive and voluntary relaxation of the urethrae sphincter and periurethral muscles [3 ▪ ].…”

Postpartum Urinary Retention

“…Postpartum urinary retention (PUR) is underrecognized and understudied, leading to confusion for both patients and nurses. Researchers do not agree on its incidence, with estimates ranging from 0.18% to 47% of postpartum women, in part due to differences the diagnostic criteria used (Li et al, 2020; Mohr et al, 2022; Nutaitis et al, 2023). The wide range of incidence estimates reflects the need for more research.…”

“…Although damage to pelvic floor muscles and the detrusor muscle increases the risk of PUR, other mechanisms such as hormonal shifts and nerve fiber distension also appear to contribute without a clear etiology (Nutaitis et al, 2023). Other possible risk factors include length of first- and second-stage labor, epidural anesthesia or systemic opioid medications, and operative vaginal birth (Li et al, 2020; Mohr et al, 2022). There is no consensus on whether newborn size is an independent risk factor.…”