Development and validation of a prediction model for urinary retention after prolapse surgery

Objectives: Postoperative urinary retention is a common and transient condition after prolapse surgery but can have serious sequelae if left untreated. Therefore, all women undergoing prolapse surgery need bladder drainage in the perioperative period, usually with the use of indwelling catheter. However, the optimal timing of catheter removal has not been clearly established. The aim of this study was to develop and validate a prediction model for postoperative urinary retention lasting > 2 and > 4 days after prolapse surgery.

Methods: Between October 2008 and February 2022, the medical records of patients (n=1,040) who underwent prolapse surgery were obtained from a tertiary hospital and divided into development (n=695) and validation (n=345) datasets. All patients underwent a spontaneous voiding trial on postoperative day 1 or 2 and those who had two consecutive voids ≥ 150 mL with a postvoid residual ≤ 150 mL were considered to have passed the voiding trial. Postoperative urinary retention was defined as the need of continuous intermittent catheterization resulting from a failed voiding trial. To construct a prediction model, we performed logistic regression using both exhaustive and stepwise variable selection, and the model was both internally and externally validated.

Results: Thirty-one and 12% of patients had postoperative urinary retention lasting > 2 and > 4 days, respectively. Models containing six predictors (age, preoperative postvoid residual, type of apical suspension procedure, concomitant hysterectomy, anterior repair and midurethral sling) showed good performance for predicting postoperative urinary retention lasting > 2 and > 4 days (area under the curve 0.73 and 0.74, respectively) and accurately predicted the observed outcomes.

Conclusions: This prediction model might be a useful tool for clinicians to personalize postoperative bladder care for patients undergoing prolapse surgery.