All patients were referred on the day of or after delivery because the PVR was greater than 500 cc or the patient was symptomatic or not able to void at all. Patients who were referred to our unit for immediate PUR from our own maternity ward, as well as from outside hospitals, were asked to participate in this study. The rate of vaginal operative delivery is 13% in our hospital. In our Department 2,300 babies are delivered annually and we have 65 gynecological beds. We performed a prospective cohort study in our tertiary referral urogynecology unit in the University Women’s Hospital of Bern, Switzerland. We hypothesize that postpartum urinary retention does not necessarily resolve spontaneously in all women. The aim of this study was to assess long-term persistence of elevated post-void residual urine volume after PUR. In particular, there is a paucity of data on long-term outcome after postpartum urinary retention and time period to normalization of post-void residual urine volume. Ĭommonly, PUR is thought to be transient, possibly because PVR is not routinely measured and therefore PUR is underdiagnosed, but data to sustain the transient nature of PUR are scarce. One study identified urination just before delivery as a preventive factor for PUR. Risk factors for PUR include: a prolonged second stage of labor (duration of labor >700 min predicts PUR ), vacuum-assisted, and instrumental delivery, (high grade) perineal lacerations, and episiotomy, degree of perineal pain, fetal birth weight, use of systemic narcotics, nulliparity, cesarean section (possibly after failure to progress in labor), epidural analgesia (possibly by modifying other obstetrical parameters such as duration of labor), intermittent catheterization during labor, an increasing number of catheterizations, and an absence of spontaneous voiding before leaving the delivery room. Prompt diagnosis and appropriate management are the key to restoring normal bladder function, but recognition is hampered by a low level of awareness amongst obstetric units and a scarcity of published literature. Complications such as urothelial lesions and urinary bladder rupture have been described. Persistent urinary retention can be a serious condition for the patient and requires management in order to prevent urogenital tract morbidity such as micturition problems due to detrusor failure, kidney failure, anuria, and hydronephrosis, even in later life. Although long-term consequences of PUR are rarely reported and small studies showed negligible if any clinical impact on long-term urogynecological disorders, only a few data are available on the potential long-term micturition problems of increased PVR after vaginal delivery. PUR can lead to denervation, detrusor atony, and bladder dysfunction if it is not recognized in time. Trauma to the pelvic floor muscles, the detrusor muscle itself, and overdistention of nerve fibers might impair bladder sensitivity, cause periurethral obstructing edema, and hormonal changes may influence bladder function as well. Levator ani muscle avulsion seems to be associated with persistent postpartum voiding dysfunction, but the etiology of PUR is thought to be multifactorial. Several theories have been suggested, including physiological, neurological, and mechanical processes during pregnancy and delivery. The pathophysiology of PUR is poorly understood. The incidence of PUR ranges from 0.18 to 47% depending on the varying definitions and the time interval of follow-up used. Overt PUR has been defined as the inability to void within 6 h of delivery or after removal of the catheter, whereas covert PUR means an increased post-void residual urine volume (PVR) of more than 150 ml after spontaneous micturition. Postpartum urinary retention (PUR) is a serious and frequent complication after childbirth.
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