PREVALENCE OF POSTOPERATIVE URINARY RETENTION AND THE OPTIMAL DURATION OF TRANSURETRAL URINARY CATHETERIZATION AFTER PELVIC FLOOR SURGERY
PETCHAROPAS1, O. CHINTHAKANAN 2;
1Dept. of OB-GYN Faculty of medicine, Chiang M, Chiang Mai, Thailand, 2Obstetrics & Gynecology Department, Ramathibodi Ho, Mahidol Univ., Bangkok, Thailand.
Introduction: Postoperative urinary retention is one of most suffering complication following pelvic floor surgery. The number of women with this complication following pelvic floor surgery are up to 24 % worldwide(1). The standard treatment of postoperative urinary retention is bladder catheterization with either prolonged catheterization or clean intermittent catheterization (CIC) (2) which are discomfort, restricted mobility, prolonged hospitalization and causing unsatisfaction after surgery. Therefore urogynecologic surgeons attempt to identify risks associated between pelvic floor surgery and postoperative urinary retention to improve surgical outcomes.
Objective: To determine the prevalence of postoperative urinary retention following pelvic floor surgery and identify risks associated between pelvic floor surgery and the optimal duration of transurethral urinary catheterization after pelvic floor surgery.
Methods: This was a retrospective cohort study of women aged 35- 85 years old diagnosed with pelvic organ prolapse (POP) and urinary incontinence (UI) who underwent pelvic floor surgical correction between January 2009 and December 2016 at tertiary referral center. Medical records of patients who met the inclusion criteria were identified. Data was analyzed by using Chi-square test and Fisher exact test for categorical data, and Student’s test and Mann-Whitney U test for continuous data. Logistic regression analysis was performed.
Results: We identified 542 potential participants who underwent pelvic floor surgery. Of those, 124 were excluded due to lack of data. 418 charts were collected. The mean age was 66.0 ± 9.1 years old. The majority of patients were menopause (85.6%). 12.2% had previous hysterectomy and 10.3% had previous incontinence or prolapse surgery. 55% were stage 3 or 4 pelvic organ prolapse and 44.5% had urinary incontinence before surgery. Seven percent (28/418) had postoperative urinary retention required prolonged Foley’s retain. All of them returned to normal after 7-10 days. Patients with previous hysterectomy were more likely to had postoperative urinary retention (28.6% vs. 12.3%, p=0.02). Operative procedures were not statistically different between two groups (Table 1). According to surgical procedure, operative data shows no significant different in operative time, blood loss, intraoperative and postoperative complications. Comparing retain Foley’s catheter 24 hours vs. more than 24 hours, urinary retention rate was not difference (9.1% vs. 6.4%, p=0.5, RR 1.5, 95% CI 0.48-4.42). There were no different of outcomes between removing Foley’s catheter in 24 hours vs. more than 24 hours.
Conclusions: Postoperative urinary retention after pelvic floor surgery was 7%. The optimal duration of retain Foley’s catheter was 24 hours. There was no significant relation between surgical procedure and postoperative urinary retention outcomes. In addition, this protocol will reduce hospital stay and cost. Therefore, catheter removal on day 1 after pelvic floor surgery is recommended.
References: 1. Urogynecology and pelvic reconstructive surgery , 2nd edn (1999) 2. Anesthesiology 110(5):1139-1157
Table 1 : Association of PUR with surgical procedures, n(%)