Prevalence of postoperative urinary retention and the optimal duration of transurethral urinary catheterization after pelvic floor surgery

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: To determine the prevalence of postoperative urinary retention following pelvic floor surgery, identify risks associated with pelvic floor surgery, and determine the optimal duration of transurethral urinary catheterization after pelvic floor surgery. Materials and Methods: This retrospective cohort study included women aged 35 to 85 years diagnosed with pelvic organ prolapse [POP] and urinary incontinence [UI] who underwent pelvic floor surgical correction between January 2009 and December 2016 at a tertiary referral center. Results: The authors identified 542 potential participants who underwent pelvic floor surgery. Of these, 161 were excluded due to lack of data, and 381 medical charts were studied. The mean age of selected participants was 66.0±9.1 years. Most patients were menopausal (95%), 13.5% had previously undergone hysterectomy, and 11.4% had previously suffered from incontinence or undergone prolapse surgery. Most patients (82.4%) had stage 3 or 4 POP and 24.9% experienced UI before surgery. Almost 7% (28/418) of patients experienced postoperative urinary retention and required insertion of a Foley catheter. All patients returned to normal after 7 to 10 days. Patients who had previously undergone a hysterectomy were more likely to experience postoperative urinary retention (28.6% versus 12.3%, p = 0.02). Operative procedures were not statistically different between urinary retention and non-urinary retention groups. A statistical difference in urinary retention rate was not observed when comparing placement of a Foley catheter for 24 hours versus more than 24 hours (9.1% versus 6.4%, p = 0.5, RR 1.5, 95% CI 0.48 to 4.42). Conclusion: The rate of postoperative urinary retention after pelvic floor surgery was approximately 7%. There was no significant correlation between surgical procedure and postoperative urinary retention outcomes. The optimal duration for placement of a Foley catheter was 24 hours. This protocol will reduce hospital stay duration and associated costs. Therefore, catheter removal 24 hours after pelvic floor surgery is recommended.