Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case–control study

Abstract

Introduction and hypothesisCovert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery.MethodsAfter the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV < 150 mL and those with PVRV ≥150 mL until 1 year after delivery. Women with PVRV ≥ 150 mL were followed until complete bladder emptying was achieved.ResultsData of 105 patients with PVRV < 150 mL and 119 with PVRV ≥ 150 mL were available for analysis. 75% of all patients included had PVRV ≥ 250 mL. More primiparous patients had PVRV ≥ 150 mL (p < 0.02). 92% of women with PVRV ≥ 150 mL after delivery were able to adequately empty their bladder within 4 days. One year after delivery, no statistically significant differences were found.ConclusionsCovert PUR according to the definition of PVRV ≥ 150 mL, is a common and transient phenomenon that does not result in more lower urinary tract symptoms 1 year after delivery. Although the current definition is not useful in identifying postpartum women with a pathological condition, we suggest that the definition of covert PUR should be change to: “PVRV≥500 mL after the first spontaneous void after (vaginal) delivery.” This cut-off value is the value at which some women do need more time to normalise emptying of the bladder. The exact clinical implications of covert PUR need to be further studied in this subcategory of women.

Postpartum urinary retention in women undergoing instrumental delivery: A cross‐sectional analytical study

“…Recently, Mulder et al suggested raising the cutoff to >500 mL, measured by ultrasonography, after spontaneous micturition to define covert PUR, following his study which assessed the clinical impact of covert PUR. 13 As injury from the perineal stretching and traction force during delivery may be greater in women undergoing instrumental delivery than a spontaneous vaginal delivery, the resulting neuropraxia or edema can result in a decrease in the bladder emptying in the immediate postnatal period. Due to this, using a cutoff of PVRBV similar to those undergoing spontaneous vaginal delivery can lead to overdiagnosis, increasing the incidence of covert PUR.…”

“…For consistent comparisons between previous studies, we also chose a definition of 150 mL for covert PUR. Recently, Mulder et al suggested raising the cutoff to >500 mL, measured by ultrasonography, after spontaneous micturition to define covert PUR, following his study which assessed the clinical impact of covert PUR 13 . As injury from the perineal stretching and traction force during delivery may be greater in women undergoing instrumental delivery than a spontaneous vaginal delivery, the resulting neuropraxia or edema can result in a decrease in the bladder emptying in the immediate postnatal period.…”

Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth International Consultation on Incontinence ‐ Research society 2018

“…2 A recent prospective case-control study showed resolution of covert PUR in 92% of the cases by day 4% and 99% by day 7. 44 The group with the covert PUR did not have more LUTS 1 year after the delivery compared with a control group without covert PUR. These findings support the idea that covert PUR is a common and ephemeral phenomenon.…”

“…However, based on the current literature, evidence that PUR is harmless is lacking . A recent prospective case‐control study showed resolution of covert PUR in 92% of the cases by day 4% and 99% by day 7 . The group with the covert PUR did not have more LUTS 1 year after the delivery compared with a control group without covert PUR.…”

“…6 Regarding the treatment of overt PUR, clean intermittent catheterization (CIC) is associated with shorter duration of intervention compared with transurethral indwelling catheterization. 48 In the randomized control study by Mulder et al, 39,41,42,44,47,48 the duration of catheterization was not related to the initial PVR volume and the first trial without the indwelling catheter was performed 24 hours after its insertion.…”