Prevalence and clinical predictors for early post-operative urinary retention in patients undergoing pelvic reconstructive surgeries: a prospective cohort study

Annie P. Vijjeswarapu, Vaibhav Londhe, Mahasampath Gowri, Aruna Kekre, Nitin Kekre


Background: Pelvic organ prolapse (POP) has a significant impact on quality of life. Post-operative voiding dysfunction is seen in 2.5 to 24% of patients following pelvic reconstructive surgery. Risk factors like age of the patient, size of the genital hiatus and stage of prolapse are known to be associated with early post-operative voiding disorders.

Methods: This is a prospective cohort study done in Christian Medical College, Vellore over one year. Patients with stage II to IV pelvic organ prolapse who underwent pelvic reconstructive surgery were observed post operatively for covert and overt urinary retention. Inability to void accompanied by pain and discomfort is defined as overt retention. Early post-operative urinary retention (POUR) is retention of urine in the first 72 hours postoperatively. Covert retention is defined as a non-painful bladder with chronic high post void residue. Chi- square test or Fisher’s exact test was used to assess the association between the clinical predictors and early post-operative urinary retention in univariate analysis.

Results: In this study, 75 patients were recruited. Nine patients had POUR. Among the patients who had post-operative urinary retention, 77.78% had stage III pelvic organ prolapse (n=7). P value was 0.042. The prevalence of early POUR after pelvic reconstructive surgery was 12.85 % (n=9). A 55.55% had covert retention (n=5) and 44.44% patients had overt retention (n=4).

Conclusions: The prevalence of early POUR after pelvic reconstructive surgery was 12.85%. Stage of the prolapse was an independent predictor for early postoperative urinary retention.


Clinical predictors, Pelvic floor repair, Pelvic organ prolapse, Post-op urinary retention, Post void residue

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Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795-806.

Kleeman S, Goldwasser S, Vassallo B, Karram M. Predicting postoperative voiding efficiency after operation for incontinence and prolapse. Am J Obstet Gynecol. 2002;187(1):49-52.

Hansen BS, Søreide E, Warland AM, Nilsen OB. Risk factors of post-operative urinary retention in hospitalised patients. Acta Anaesthesiol Scand. 2011;55(5):545-8.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urol. 2003;61(1):37-49.

Carley ME, Carley JM, Vasdev G, Lesnick TG, Webb MJ, Ramin KD, et al. Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. Am J Obstet Gynecol. 2002;187(2):430-3.

Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, et al. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg. 2005 Aug;101(2):592–596, table of contents.

Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110(5):1139-57.

Kemp D, Tabaka N. Postoperative urinary retention: Part II: A retrospective study. J Post Anesth Nurs. 1990;5(6):397-400.

Pant PR. An effective short duration postoperative catheterization after vaginal hysterectomy and pelvic floor repair. Journal of Institute of Medicine. 2007 Jan 22;28(1).

Lamonerie L, Marret E, Deleuze A, Lembert N, Dupont M, Bonnet F. Prevalence of postoperative bladder distension and urinary retention detected by ultrasound measurement. Br J Anaesth. 2004;92(4):54-6.

Ansell I. The Anatomy and Physiology of Micturition and the Effect of various Neurological Disorders upon this Function. Postgrad Med J. 1944;20(229):333-9.

Komesu YM, Rogers RG, Kammerer-Doak DN, Olsen AL, Thompson PK, Walters MD. Clinical predictors of urinary retention after pelvic reconstructive and stress urinary incontinence surgery. J Reprod Med. 2007 Jul;52(7):611-5.

Subak LL, Johnson C, Whitcomb E, Boban D, Saxton J, Brown JS. Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):40-3.

Revicky V, Mukhopadhyay S, de Boer F, Morris EP. Obesity and the incidence of bladder injury and urinary retention following tension-free vaginal tape procedure: retrospective cohort study. Obstet Gynecol Int. 2011;2011:746393.

Tinelli A, Malvasi A, Rahimi S, Negro R, Vergara D, Martignago R, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause NYN. 2010 Feb;17(1):204-12.

Ghafar MA, Chesson RR, Velasco C, Slocum P, Winters JC. Size of urogenital hiatus as a potential risk factor for emptying disorders after pelvic prolapse repair. J Urol. 2013 Aug;190(2):603-7.

Shafik A, El-Sibai O. Effect of levator ani muscle contraction on urethrovesical and anorectal pressures and role of the muscle in urination and defecation. Urol. 2001 Aug;58(2):193-7.

Miller EA, Amundsen CL, Toh KL, Flynn BJ, Webster GD. Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol. 2003 Jun;169(6):2234-7.

Fitzgerald MP, Kulkarni N, Fenner D. Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse. Am J Obstet Gynecol. 2000 Dec;183(6):1361-1363.

Phipps S, Lim YN, McClinton S, Barry C, Rane A, N’Dow J. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev. 2006;(2):CD004374.

Sekhavat L, Farajkhoda T, Davar R. The effect of early removal of indwelling urinary catheter on postoperative urinary complications in anterior colporrhaphy surgery. Aust N Z J Obstet Gynaecol. 2008 Jun;48(3):348-52.

Thapa M, Shrestha J, Pradhan BN, Padhye SM. Bacteriuria and urinary retention following gynaecological surgery: comparing short vs long term catheterization. J Nepal Health Res Counc. 2010 Oct;8(2):107-9.

Petros JG, Bradley TM. Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg. 1990;159(4):374-6.

Hakvoort RA, Dijkgraaf MG, Burger MP, Emanuel MH, Roovers JPWR. Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn. 2009;28(3):225-8.