Levator ani muscle avulsion: a risk factor for persistent postpartum voiding dysfunction

Introduction and hypothesis Persistent postpartum voiding dysfunction (P-PPVD) is defined as the inability to empty the bladder properly 72 h after delivery despite the use of intermittent urinary catheterization. Our aim was to find predictive factors for P-PPVD and to compare its urogynecologic outcomes with transient dysfunctions. Materials and methods A case-control study was performed in a university hospital center between January 2018 and April 2019. The case group included women diagnosed with P-PPVD after vaginal delivery, and the control group included women with PPVD that resolved before 72 h. Patients were followed up at 12 weeks and 12 months postpartum, including an ultrasound assessment of the levator ani muscle (LAM). Results Of 2308 deliveries, 1894 (81%) were vaginal, 75 (3.85%) presented PPVD, and 1 lasted > 72 h (0.69% P-PPVD). LAM avulsion (OR 6.3, 95% CI 1.24-32.01) was the only independent risk factor for P-PPVD found. No significant differences in urogynecologic symptoms between transient and persistent PPVD were found in the short and the long term, except that women with P-PPVD had a lower prevalence of urinary incontinence at 12 weeks postpartum. Conclusions PPVD is a common, self-limited event, but in 17.3% of cases persists > 3 days. Levator ani muscle avulsion acts as an independent risk factor for P-PPVD. Early diagnosis and appropriate treatment of P-PPVD can help minimize any clinical implications for long-term urogynecologic disorders.