Retrospective Cohort Study on the Perioperative Risk Factors for Transient Voiding Dysfunction After Apical Prolapse Repair

Abstract

Objectives The primary aim was to compare the incidence of transient voiding dysfunction (TVD) between vaginal uterosacral ligament suspension, sacrospinous ligament fixation, and robotic sacrocolpopexy. Secondarily, we identified risk factors for TVD and associated postoperative complications. Methods This was a retrospective cohort study of women who underwent apical repair at 1 institution. Data were collected from electronic medical records and were presented as means (SD) or numbers (percent) as appropriate. Univariate and multivariate analyses were performed to identify risk factors for TVD and its associated postoperative complications. Results Three hundred sixty women were included in analysis. Two hundred nineteen (60.8%) passed their voiding trial and 141 (39.2%) experienced TVD. The TVD group demonstrated a higher age, age-adjusted Charlson Comorbidity Index score, and preoperative postvoid residual (all P < 0.05). Univariate analysis demonstrated higher rates of TVD in the vaginal uterosacral ligament suspension and sacrospinous ligament fixation groups compared with the robotic sacrocolpopexy group (P = 0.012). Transient voiding dysfunction occurred more frequently with a concomitant anti-incontinence procedure, anterior repair, and/or posterior repair (all P < 0.05). In multivariate analysis, only an anti-incontinence procedure and concomitant anterior repair were independently associated with a risk of TVD (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.37–3.62, and OR, 2.20; CI, 1.14–4.27, respectively). Transient voiding dysfunction was associated with a culture-proven urinary tract infection within 6 weeks (OR, 3.2; CI, 1.3–8.55). Conclusions There was no difference in TVD between types of apical repair. Concomitant anti-incontinence procedure and anterior repair were associated with TVD. Women with TVD have an increased risk of postoperative urinary tract infections.

Voiding function after sacrocolpopexy versus native tissue transvaginal repair for apical pelvic organ prolapse in an ERAS era: A retrospective cohort study

“…Overall, only 23% of our cohort failed their first active voiding trial compared to 70% of women undergoing multi-compartment vaginal native tissue repair at our institution prior to ERAS implementation (3). Similarly, in a retrospective study of 360 patients who underwent apical repair via uterosacral ligament suspension, sacrospinous ligament fixation or robotic sacrocolpopexy, the overall failure rate was 39% (2). ERAS protocols typically advocate for the incorporation of standing doses of anti-inflammatory medication and acetaminophen without utilization of narcotics, a regimen that improves pain without interfering with return of bladder function.…”

“…Rates of postoperative incomplete bladder emptying after pelvic reconstructive surgery have a wide reported variance that ranges from 13% [1] to 39% [2]. Factors affecting postoperative urinary retention (POUR) include the timing of the voiding trial [3], method of prolapse repair [4], concomitant hysterectomy, larger cystoceles, severe intra-operative blood loss, levator plication, and Kelly plication [5].…”

Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

“…Transient urinary retention requiring temporary catheterization occurs commonly after both reconstructive and obliterative pelvic organ prolapse surgery 1–5 . Many studies have identified possible risk factors for the development of postoperative urinary retention after prolapse repairs; however, the optimal strategy for catheter management postoperatively is unclear 1–3,6 .…”

“…[1][2][3][4][5] Many studies have identified possible risk factors for the development of postoperative urinary retention after prolapse repairs; however, the optimal strategy for catheter management postoperatively is unclear. [1][2][3]6 Options for managing postoperative transient urinary retention include indwelling transurethral catheter (TUC), clean intermittent catheterization (CIC), and planned suprapubic catheter (SPC) placement at the time of prolapse repair. Each option has unique advantages and disadvantages to include urinary tract infection (UTI) risk, ease of patient use, and patient comfort.…”

“…T ransient urinary retention requiring temporary catheterization occurs commonly after both reconstructive and obliterative pelvic organ prolapse surgery. [1][2][3][4][5] Many studies have identified possible risk factors for the development of postoperative urinary retention after prolapse repairs; however, the optimal strategy for catheter management postoperatively is unclear. [1][2][3]6 Options for managing postoperative transient urinary retention include indwelling transurethral catheter (TUC), clean intermittent catheterization (CIC), and planned suprapubic catheter (SPC) placement at the time of prolapse repair.…”