Postoperative Urinary Retention

Abstract

This clinical consensus statement on the management of postoperative (<6 weeks) urinary retention (POUR) reflects statements drafted by content experts from the American Urogynecologic Society's POUR writing group. The writing group used a modified Delphi process to evaluate statements developed from a structured literature search and assessed for consensus. After the definition of POUR was established, a total of 37 statements were assessed in the following 6 categories:(1) incidence of POUR, (2) medications, (3) patient factors, (4) surgical factors, (5) urodynamic testing, and (6) voiding trials. Of the 37 original statements, 34 reached consensus and 3 were omitted.

Active Compared With Passive Voiding Trials After Midurethral Sling Surgery

“…Delayed postoperative urinary retention is a rare complication that can cause patients to have severe pain and require an urgent visit for catheter placement. 3 Identifying patients at risk would be helpful for clinicians, but there are few identifiable risk factors outside of the initial postoperative voiding trial. A standardized assessment would be key in future studies to determine what these risk factors are.…”

“…No specific PVR or voided volume measurement has been proven to be superior in the literature; thus, the criteria for passing voiding trials varied widely. 3 These differing criteria may affect our results in that no universal protocol was followed, which limits our ability to determine which method is better for detecting postoperative urinary retention. To account for these varying definitions of voiding trial failure and the multitude of variables, two primary outcomes were identified to better quantify a passed compared with failed trial of void.…”

“…This must be kept in mind when studies are compared. 3 In contrast to Geller et al, 36 Popiel et al 37 defined accuracy as any patient who required catheterization after a successful trial of void (delayed postoperative urinary retention). In this randomized controlled trial of 109 patients, they compared active and passive techniques after urogynecologic surgery, and both were equivalent.…”

“…Similarly, the American Urogynecologic Society recently published a 2023 consensus statement for postoperative urinary retention stating that, according to currently published systematic reviews, no evidence exists of a difference in trial of void failure rates between the active and passive methods. 3 Again, this was a review of urogynecologic literature. These results shed light on the differences in postoperative urinary retention between procedure types that should be considered when trial of void approach is considered.…”

“…Postoperative urinary retention is defined as the inability to voluntarily pass an adequate amount of urine after a surgical procedure; delayed postoperative urinary retention is described in the American Urogynecologic Society's consensus statement as occurring when a patient initially passes a trial of void but then subsequently presents in retention. 3 The risk of delayed postoperative urinary retention, according to a Cochrane review, is 1.6% in patients after a retropubic sling and 0.5% in patients after a transobturator sling. However, the retention rate in the recovery room is higher (7–52%).…”