Risk factors for postpartum urinary retention: a systematic review and meta‐analysis

Abstract

Background Postpartum urinary retention (PUR) is a common condition with varying prevalence. Measurement of the post-void residual volume (PVRV) is not regularly performed. Various studies have been published on overt (the inability to void after giving birth, requiring catheterisation) and covert (an increased PVRV after spontaneous micturition) PUR. To evaluate which clinical prognostic factors are related to PUR, the identification of independent risk factors for covert and overt PUR is needed.Objectives We performed a systematic review and meta-analysis of observational studies reporting on risk factors for PUR.Search strategy Systematic search of MEDLINE and EMBASE to September 2011.Selection criteria Articles that reported on women diagnosed with PUR or with an abnormal PVRV.Data collection and analysis The included articles were selected by two authors. We constructed two-by-two tables for potential risk factors of overt and covert PUR and calculated pooled odds ratios (ORs) with 95% confidence intervals.Main results Twenty-three observational studies with original data were eligible for data extraction, of which 13 could be used for meta-analysis. Statistically significant risk factors for overt PUR were epidural analgesia (OR 7.7), instrumental delivery (OR 4.5), episiotomy (OR 4.8) and primiparity (OR 2.4). For covert PUR, variety in the definitions used resulted in heterogeneity; no significant prognostic factors were found.Conclusions Instrumental delivery, epidural analgesia, episiotomy and nulliparity are statistically significantly associated with a higher incidence of overt PUR. The same factors were identified for covert PUR, but without statistical significance. Uniformity in definitions in future research is essential to create a prognostic model.

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

“…The possibility of the influence of these factors in the observed impairment of voiding might be reflected by the observation that the occurrence of PUR is higher in patients with epidural analgesia, episiotomy, and higher birth weight [6, 7]. …”

Effect of epidural analgesia with opioids on the prevalence of urinary retention in dogs undergoing surgery for cranial cruciate ligament rupture

“…[1][2][3][4][5][6][7][8][9] Epidural administration of opioid medications decreases parasympathetic firing in the sacral region by acting on µ and δ fibers, thereby decreasing afferent inputs from the urinary bladder to the spinal cord. [1][2][3][4][5][6][7][8][9] Epidural administration of opioid medications decreases parasympathetic firing in the sacral region by acting on µ and δ fibers, thereby decreasing afferent inputs from the urinary bladder to the spinal cord.…”

“…10,11 A similar effect occurs following IV or IM administration of opioids through their action on µ receptors in the spinal cord, inhibiting the release of acetylcholine from parasympathetic sacral nerves that control detrusor tone. [1][2][3][4] Although urinary retention after spinal administration of opioids has been documented clinically and experimentally in dogs, epidural administration has not been evaluated. [1][2][3][4] Although urinary retention after spinal administration of opioids has been documented clinically and experimentally in dogs, epidural administration has not been evaluated.…”

“…2,14 Changes in micturition volume thresholds have been detected experimentally in dogs following both spinal (subdural) and systemic opiate administration. Urinary retention in humans can be broadly classified into 2 categories: overt urinary retention (failure to initiate voiding, regardless of whether the need to urinate is perceived), and covert urinary retention (failure to fully void urine volume following micturition attempts).…”

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

“…Episiotomy, epidural analgesia, and birth weight were independent risk factors for covert PUR following multivariate regression analysis. A previous systematic review had reported epidural analgesia (OR, 7.7), episiotomy (OR, 4.8), instrumental delivery (OR, 4.5), and primiparity (OR, 2.4) as risk factors for overt PUR …”