Postoperative urinary retention after pelvic organ prolapse surgery: influence of peri-operative factors and trial of void protocol

Purpose Transient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively. Methods We conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015 to October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to "pass" the protocol. Results Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension. A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI1.6-2.9) and 2.3 (95% CI 1.8-3.1) times more likely to have elevated PVR after their second TOV and third TOV (p < 0.0001), respectively, compared with those without concomitant MUS. Permitting a third TOV allowed an additional 10% of women to pass the voiding protocol before discharge. The median number of voids to pass protocol was 2. An ASA > 2 and placement of MUS were associated with increasing number of voids needed to pass protocol. Conclusions While many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations.