Risk Factors for Urinary Retention After Colpocleisis

Abstract

Objectives Transient urinary retention occurs frequently after pelvic organ prolapse surgery. While the prevalence of postoperative urinary retention has been reported for reconstructive procedures, a paucity of data exists for colpocleisis. The objectives of this retrospective cohort study were to identify risk factors for transient urinary retention after colpocleisis and to determine the rate of its occurrence. Methods A retrospective chart review was performed for patients undergoing colpocleisis from January 2015 to December 2019 in a high-volume urogynecology practice. Patients were excluded if they required prolonged catheterization postoperatively because of a surgical complication or used a catheter before surgery, or if a suprapubic catheter was placed during surgery. Potential patient and procedural risk factors were analyzed. Transient urinary retention was diagnosed if patients failed their postoperative voiding trial and went home with a catheter. Results A total of 172 patients met the inclusion criteria. The incidence of transient postoperative urinary retention was 55%, with rates of 36.7% with LeFort colpocleisis, 51.5% with posthysterectomy colpocleisis, and 64.9% with colpocleisis with concomitant hysterectomy. Logistic regression revealed an increased risk of postoperative urinary retention if hysterectomy was performed at the time of colpocleisis (odds ratio, 2.9; confidence interval, 1.23–6.84; P = 0.015). Patient age, prolapse severity, preoperative postvoid residual volume, and concomitant anti-incontinence procedure were not associated with transient postoperative urinary retention. Conclusions Transient urinary retention occurs in more than half of patients after colpocleisis. Patients undergoing concomitant hysterectomy have the highest risk of postoperative urinary retention. Surgeons can use this information both for counseling and management decisions for individual patients.

Frailty and Acute Postoperative Urinary Retention in Older Women Undergoing Pelvic Organ Prolapse Surgery

“…only 5.5% undergoing a concomitant incontinence procedure. Generally, the incidence of POUR after prolapse surgery ranges from 3% to 29%, 4,8,25 although higher rates exist for patients undergoing colpocleisis (55%) 26 or a concomitant sling procedure (as high as 86.2%). 27 The reported incidence of POUR in our study is generally consistent with published findings, given the mean age of our cohort and our institution's stricter clinical criteria for a failed voiding trial (PVR of >100 mL).…”

Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

“…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.…”

“…12,13 After this procedure, approximately half of patients will require temporary catheterization. 4,5 Because many women undergoing this procedure would have difficulty performing CIC due to medical comorbidities and challenges with dexterity, options for catheter management are typically limited to either TUC or planned placement of an SPC at the time of surgery. Previous studies examining the risks and benefits between those options after gynecologic surgery have yielded mixed results in terms of UTI risk, with some studies indicating a lower risk with SPC and others indicating similar risk for SPC and TUC.…”