AUGS Clinical Consensus Statement: Postoperative Urinary Retention

ABSTRACT

This clinical consensus statement on the management of postoperative (<6 weeks)

urinary retention (POUR) reflects statements drafted by content experts from the American Urogynecologic Society’s POUR writing group. The writing group used a modified Delphi process to evaluate statements developed from a structured literature search and assessed for consensus. After the definition of POUR was established, a total of 37 statements were assessed in the following 6 categories: (1) incidence of POUR, (2) medications, (3) patient factors, (4) surgical factors, (5) urodynamic testing, and (6) voiding trials. Of the 37 original statements, 34 reached consensus and 3 were omitted.

WHY THIS MATTERS

Postoperative urinary retention is a common outcome after surgical procedures for pelvic organ prolapse and stress urinary incontinence. Without appropriate treatment, it can lead to postoperative morbidity with issues of urinary tract infection, detrusor dysfunction, overflow incontinence, and, in severe cases, renal dysfunction. As a result, recognizing, treating, and trying to prevent this adverse event are important for pelvic reconstructive surgeons. Numerous perioperative risk factors that could predispose a patient to developing POUR have been studied. Identifying the truly relevant risk factors would help surgeons address these issues and decrease the incidence. Furthermore, methods of identifying POUR and then subsequently treating it are vast and varied in the literature. As such, a critical evaluation of the current evidence on how to approach and manage this condition.

Postoperative urinary retention (POUR) is common after reconstructive surgery for pelvic organ prolapse and urinary incontinence, and the incidence ranges from 15% to 45%.1–4 Multiple studies in the urogynecologic literature evaluate the incidence of POUR; however, there is little consensus regarding the definition, methods of diagnosis, postoperative interventions, or the patient and surgical risk factors for POUR. In 2018, the International Urogynecological Association developed a committee opinion on the management of postmidurethral sling voiding dysfunction that addressed the role of medications, physiotherapy, as well as timing and type of surgical intervention,5 but the terms “voiding dysfunction” and POUR were noted to be overlapping but not synonymous. Furthermore, in the urologic literature, there are no specific guidelines for POUR in women.6–10 Clinical consensus statements (CCSs) are often used in situations “where evidence is limited or lacking, yet there are still opportunities to reduce uncertainty and improve the quality of care.”11 The purpose of this American Urogynecologic Society (AUGS) POUR CCS was to summarize the existing evidence regarding patient and surgical risk factors, postoperative interventions, voiding trial (VT) methods, and catheter management approaches. In addition, the goal of this work was to identify gaps in the literature and opportunities for future research. We hypothesized that there would be sufficient evidence and/or clinical agreement among experts to recommend certain actions around the diagnosis, risks factors, and management of POUR, although some important aspects of POUR would have limited evidence.

REFERENCES

1. Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–838. doi:10.2147/IJWH.S55383.

2. Sokol AI, Jelovsek JE, Walters MD, et al. Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery. Am J Obstet Gynecol. 2005;192(5):1537–1543. doi:10.1016/j.ajog.2004.10.623.

3. Chung SM, Moon YJ, Jeon MJ, et al. Risk factors associated with voiding dysfunction after anti-incontinence surgery. Int Urogynecol J. 2010;21(12):1505–1509. doi:10.1007/s00192- 010-1229-7.

4. Baessler K, Christmann-Schmid C, Maher C, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8(8):CD013108. doi:10.1002/14651858.CD013108.

5. Bazi T, Kerkhof MH, Takahashi SI, et al, IUGA Research and Development Committee. Management of post-midurethral sling voiding dysfunction. International Urogynecological Association research and development committee opinion. Int Urogynecol J. 2018;29(1):23–28. doi:10.1007/s00192-017-3509-y.

6. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J Urol. 2021;206(5):1097–1105. doi:10.1097/JU.0000000000002235.

7. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up. J Urol. 2021;206(5):1106–1113. doi:10.1097/JU.0000000000002239.

8. Lerner LB, McVary KT, Barry MJ, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part II–surgical evaluation and treatment. J Urol. 2021; 206(4):818–826. doi:10.1097/JU.0000000000002184.

9. Lerner LB, McVary KT, Barry MJ, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I–initial work-up and medical management. J Urol. 2021;206(4):806–817. doi:10.1097/JU.0000000000002183.

10. Winters JC, Dmochowski RR, Goldman HB, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl): 2464–2472. doi:10.1016/j.juro.2012.09.081.

11. Rosenfeld RM, Nnacheta LC, Corrigan MD. Clinical consensus statement development manual. Otolaryngol Head Neck Surg. 2015;153(2 suppl):S1–S14. doi:10.1177/ 0194599815601394.

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