Post‐partum voiding dysfunction and urinary retention

Abstract

Voiding difficulty and urinary retention is a common phenomenon in the immediate post-partum period. The importance of prompt diagnosis and appropriate management of this condition cannot be over-emphasised as it is the key to ensuring a rapid return to normal bladder function. Despite this, studies revealed a low level of awareness of this problem amongst obstetric units, and there is little information regarding this condition in the published literature. This article aims at reviewing the available literature and providing an informative guide as to the associated risk factors, pathogenesis, clinical presentation and management of this largely overlooked condition.

Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study

“…Because of this disagreement, and as asymptomatic cases often remain undiagnosed, the exact incidence of PPUR is unknown. However, in the literature, the estimated incidence of PPUR varies between 0.05% and 37 % (7). Postpartum urinary retention has been classified into overt and covert retention by Yip et al (3).…”

“…Covert (asymptomatic) urinary retention is defined as having a postvoid residual bladder volume (PVRBV) of more than 150 mL, detected by ultrasound or by catheterization, with no symptoms of urinary retention. The precise pathophysiology of PPUr is still unknown; however, it is likely to be multifactorial, including physiological, neurological, and mechanical processes in the postpartum period (7). Inappropriate or delayed diagnosis and management of PPUR can lead to bladder dysfunction, urinary tract infection, and catheter-related complications (8).…”

Management of Bladder Dysfunction and LUTs During Pregnancy

“…Patients can present with a complete inability to void, asymptomatic or exhibit small voided volumes, urinary frequency or urgency, a slow or intermittent stream, hesitancy, bladder pain or discomfort, urinary incontinence, straining to void or sense of incomplete emptying [32]. Distension can be diagnosed with palpation; however, it is too insensitive to diagnose PPUR as the bladder needs to be distended to >300 ml.…”

“…If the patient fails the TOV again in a week, she should be taught to self-catheterize and perform timed voids every 3-4 h. The continence nurse could liase closely to ensure the patient is competent in performing self catherization and to determine frequency of self-catheterization. It is reasonable to discontinue catheterization when the residual urine volume is <150 ml and the patient no longer has significant symptoms of voiding difficulty [32].…”

Postpartum İdrar Retansi̇yonu (Postpartum Urinary Retention)

“…-108- (36,37). Bu basit noninvaziv yöntemler ile lohusaların yaklaşık yarısında spontanmiksiyon meydana gelebilmektedir (7,11).…”