The Association of Preoperative Medication Administration and Preoperative and Intraoperative Factors With Postoperative Urinary Retention After Urogynecologic Surgery

Abstract

Objectives The aim of this study was to determine if preoperative medication administration is associated with postoperative urinary retention (PUR) after urogynecologic procedures and identify preoperative and intraoperative factors that are predictive of PUR. Methods A retrospective review of patients who underwent prolapse and/or incontinence surgery was performed. The primary outcome was PUR, defined as postoperative retrograde void trial with postvoid residuals of greater than 100 mL. Bivariate analysis was performed to compare demographics and preoperative and intraoperative characteristics of women with and without PUR, and multivariable logistic regression modeling was used to identify independent predictors of PUR. Results Of women in this cohort, 44.8% (364/813) had PUR. There were no significant differences in preoperative medication administration in women with and without PUR. Age older than 60 years (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09–2.02), combined prolapse and incontinence surgery (aOR, 1.84; 95% CI, 1.29–2.62), vaginal hysterectomy (aOR, 1.66; 95% CI, 1.66–2.38), and procedure time (aOR, 1.01; 95% CI, 1.00–1.01) were associated with increased odds of PUR, whereas laparoscopic sacrocolpopexy was associated with lower odds (aOR, 0.22; 95% CI, 0.10–0.46). Discussion Although preoperative medication administration was not associated with PUR, other clinically important variables were age older than 60 years, vaginal hysterectomy, incontinence and prolapse surgery, or longer procedure time. Sacrocolpopexy reduced the odds of PUR by approximately 80%. These factors may be useful in preoperative and postoperative counseling regarding PUR after urogynecologic surgery.

Postoperative Urinary Retention

“…Thus, the published incidence of POUR broadly ranges between 15% and 45% 1–4,117–119 . Several studies have shown the rate of POUR after isolated MUS is less than when the MUS is placed at the time of prolapse repair, particularly those performed vaginally, with or without hysterectomy 20,120 . When it comes to colpocleisis, several studies have demonstrated that concurrent MUS does not increase the risk of POUR 31–35 .…”

“…Several commonly used perioperative medications affect voiding function. Anticholinergics, volatile anesthetics, opioids, and scopolamine may contribute to detrusor underactivity via their antagonistic action on muscarinic receptors 20,24–26 . Although the authors of these studies speculate that nonsteroidal anti-inflammatory drugs may be associated with detrusor underactivity due to inhibition of prostaglandin-mediated detrusor muscle contraction, these theories are based on observational studies from other surgical subspecialties 56,121 …”

“…Studies specific to urogynecology have demonstrated that patient factors, such as medical history, prolapse stage, preexisting urinary symptoms, and preoperative urodynamic findings, are associated with POUR 16–26 . Perioperative factors, such as surgical route, concomitant procedures, surgical length, blood loss, anesthesia type, perioperative medications, intraoperative fluid management, and postoperative pain control, also may contribute to POUR 20,24–26 …”

Effects of Preoperative Gabapentin on Clinical Outcomes After Outpatient Midurethral Sling Placement

“…Previously established benefits of ERAS in pelvic reconstructive surgery include decreased length of stay with similar rates of postoperative complications and emergency department visits, but with increased rates of PUR and 30-day readmission 15 . Schmidt et al 14 evaluated the association of PUR and ERAS preoperative medications, including phenazopyridine, acetaminophen, and gabapentin and found no increased risk of PUR. However, patients undergoing an isolated midurethral sling make up a minority of the study populations; therefore, the aforementioned findings may have been underpowered and not fully generalizable to this specific patient population.…”

“…Risk factors for urinary retention after pelvic reconstructive surgery include increasing age, medical comorbidities, degree of prolapse, procedure time, surgical blood loss, pain, and concomitant midurethral sling placement 10–13 . In addition, with the recent implementation of enhanced recovery after surgery (ERAS) protocols in pelvic reconstructive surgery, studies are forthcoming regarding the effects of these interventions on PUR 14 …”