Urinary retention following urethral bulking alone versus with concomitant prolapse surgery

Objectives: To evaluate whether concomitant pelvic organ prolapse (POP) surgery and polyacrylamide hydrogel (PAHG) urethral bulking is associated with postoperative urinary retention among women receiving PAHG urethral bulking in the operating room.

Methods: This retrospective cohort study included women with stress urinary incontinence or mixed urinary incontinence who underwent PAHG bulking under sedation or general anesthesia from January 2019 to September 2022. Urinary retention, the primary outcome measure, was defined as postoperative urinary retention requiring Foley catheter placement or intermittent straight catheterization. Bivariate analysis was used to compare baseline characteristics in women who received PAHG alone compared with women who received PAHG and POP surgery (PAHG+POP). Univariate analysis compared urinary retention in PAHG versus PAHG+POP. Select variables were used in multivariate logistic models for odds ratios and significance was defined as two-tailed p< 0.05 for all tests.

Results: 170 women received PAHG from 2019-2022 and 86 total (50.6%) women met eligibility criteria. There were 40 (46.5%) women who underwent PAHG bulking alone while 46 (57.5%) had a concomitant prolapse repair (PAHG+POP). Patients in the PAHG+POP group were older (mean 65 versus 56 years; p< 0.05) and had a lower median (IQR) body mass index (BMI) 27.0 (24.0 – 31.0) versus 31.0 (26.0 – 36.0), p=0.02. In bivariate analysis (Table 1) postoperative urinary retention was associated with PAHG+POP (versus PAHG alone) and hysterectomy (versus no hysterectomy). The multivariable logistic regression model included age ≥ 65 years, BMI ≥30, White and non-Hispanic race/ethnicity, anterior colporrhaphy, preoperative voiding symptoms, and hysterectomy as potential predictors of urinary retention (Table 2). In the multivariate model, the odds of urinary retention were not associated with PAHG+POP versus PAHG alone (OR = 3.42; 95% CI [0.74 – 15.88]; p=0.12). Patients who had concomitant hysterectomy with PAHG were 6 times more likely to develop postoperative urinary retention (OR = 5.97; 95% CI [1.07 – 33.24]; p=0.04).

Conclusions: There was no difference in postoperative urinary retention in patients having PAHG injection alone versus those receiving PAHG injection in combination with a POP surgery. There was a higher risk of postoperative urinary retention in patients undergoing a hysterectomy at the time of the PAHG injection.