Impact of Voiding Trial on Postoperative Urinary Retention After Pelvic Reconstructive Surgery

Objectives: Temporary urinary retention after pelvic reconstructive surgery requiring indwelling catheter or self-catheterization usage occurs in approximately 30-60% of patients postoperatively. The current methods to evaluate for postoperative urinary retention include a “passive” voiding trial (awaiting urge to void) and an “active” voiding trial (retro-fill Foley catheter followed by an attempt to void). There is scarcity of data on efficiency and precision of each technique to detect temporary urinary retention after urogynecological surgery. This study aimed to compare the urinary retention detection rate and time required in the recovery unit for completion of voiding trial between active and passive voiding trials.

Methods: This is an IRB approved, retrospective observational cohort study of patients who underwent mid-urethral sling placement (and subsequent voiding trials prior to discharge) with or without concomitant prolapse from 6/1/2019 to 6/30/2022 at our Midwest academic health center. Subjects underwent passive- versus active- voiding trial based on attending physician preference. Data was analyzed using SAS 9.4 (SAS Inc., Cary, NC). Demographic variables and differences between groups were compared using Student t-test (parametric) or Mann-Whitney U test (nonparametric) for continuous variables and chi-squared test or Fisher exact test for categorical variables. Predictors significant at p-value < 0.05 were included in a multivariable model. Statistical significance was defined at p-value < 0.05.

Results: Two hundred and eight-five subjects who underwent voiding trial on postoperative day 0 were recruited with average age of 60-years, and BMI of 28.7. Of these subjects, 94 underwent an active voiding trial and 191 underwent a passive voiding trial. There was no statistically significant difference between the rate of postoperative urinary retention between groups (30.85% vs. 29.32%, p=0.79) or time from surgery end to voiding trial (233.05 ± 167.56 minutes vs. 203.14 ± 147.82 minutes, p=0.13), active versus passive, respectively (Table 1). While categorizing patients to those who failed versus passed the voiding trial, the rate of urinary retention increased from 10% to 29.3% when mid-urethral sling placement was accompanied by concomitant prolapse repair procedure. Among all variables including patient’s baseline demographics, type of anesthesia, length of procedures, and types of procedures, multivariate logistic regression showed a correlation between postoperative urinary retention and undergoing a combined anterior and posterior colporrhaphy (OR 5.127, p < 0.0001) as well as undergoing a vaginal apical prolapse procedure (OR 2.749, p=0.0045) (Table 2).

Conclusions: There was no observed difference in postoperative urinary retention detection rate or time from surgery end to voiding trial or discharge based on type of voiding trial (active versus passive) after pelvic reconstructive surgery. Combined anterior and posterior colporrhaphy and vaginal apical suspension were correlated with an increased rate of postoperative urinary retention.