Predicting Short‐Term Urinary Retention After Vaginal Prolapse Surgery

Abstract

Urinary retention after vaginal prolapse surgery occurs more frequently in women with larger cystoceles, severe intra-operative blood loss and the application of levator plication and Kelly plication.

Predictors for Voiding Trial Failure after Minimally Invasive Sacrocolpopexy

“…This retrospective cohort study of 290 patients at a single institution over a 3 year period reported a 27.2% failure rate, however, this cohort included patients who underwent concomitant mid-urethral slings, which are known risk factors for postoperative urinary retention (and were excluded from our study for this reason specifically). In terms of voiding trial failure rates after vaginal prolapse surgery, rates ranging from 29% to 32% have been observed; much higher than those seen in our study [4]. This is potentially explained by increased edema and tissue destruction surrounding the urethra caused by aggressive dissection and manipulation required by extensive vaginal surgery.…”

“…Data are mixed regarding the effect of an anterior repair on voiding trial failure, with some studies noting an association3, while other have been unable to do so4. In the latter study, a higher prevalence of voiding dysfunction in patients with a high grade cystocele and the application of a posterior repair was also been observed [4]. Geller et al [13] examined a wide variety of procedures including vaginal, abdominal, laparoscopic and robotic, while Hakvoort et al [4] examined exclusively vaginal procedures, thus, results may not be entirely generalizable to our patient population.…”

“…In the latter study, a higher prevalence of voiding dysfunction in patients with a high grade cystocele and the application of a posterior repair was also been observed [4]. Geller et al [13] examined a wide variety of procedures including vaginal, abdominal, laparoscopic and robotic, while Hakvoort et al [4] examined exclusively vaginal procedures, thus, results may not be entirely generalizable to our patient population. In the aforementioned study by Turner et al [13] examining preoperative risk factors for voiding dysfunction in patients undergoing a minimally invasive sacrocolpopexy, none of the 290 patients who underwent a minimally invasive sacrocolpopexy had a concomitant vaginal surgery, thus the potential for this variable to cause postoperative voiding dysfunction was unable to be analyzed.…”

“…In the field of urogynecology, prolonged catheterization is a reality for many patients, especially in the postoperative setting. Postoperative voiding dysfunction after prolapse surgeries with or without incontinence surgery have been estimated between 22-62% [2][3][4][5]. Pelvic organ prolapse affects one in 10 women [6] and approximately 200,000 patients per year undergo a prolapse surgery in the United States [7].…”

ISC in women following urogynaecologic surgery

“…The rates of retention reported following transurethral injection of bulking agents such as collagen are around 15% with a low risk of prolonged retention ( (National Institute for Health and Clinical Excellence (NICE) , Stothers, Goldenberg andLeone, 1998). The rate of retention following surgery to repair vaginal prolapse, without incontinence procedures is estimated at 29% (Hakvoort, 2009), however, in practice, women will undergo a combination of procedures aimed at treating both prolapse and incontinence, which increases their rsik of developing post-operative retention (Geller, 2014).…”