54: Is hysterectomy a risk factor for urinary retention? A retrospective matched case control study

Abstract

Urinary retention has been reported in up to 20% of outpatient minimally invasive hysterectomies. Studying the independent effect of hysterectomy on urinary retention is difficult because of the presence of multiple risk factors, which include menopause, perioperative opioid administration, and operative time. This is a retrospective chart review comparing patients who underwent minimally invasive hysterectomy to those who underwent non-hysterectomy minimally invasive gynecologic surgery between January 2013 and December 2018 at a single institution. The primary outcome was rate of urinary retention. A total of 200 hysterectomy cases were matched by operative time to non-hysterectomy gynecologic surgery controls in a 1:1 ratio. Differences in baseline and operative characteristics between the two groups (Table 1) included age (years, 48.6 vs. 45.7, p = 0.04), perioperative opioid administration (morphine mg equivalents, 11.6 vs. 7.6, p = 0.01) and estimated blood loss (EBL, mL, 64.1 vs. 31.8, p=0.001); menopausal status and body mass index (BMI) did not differ. Rate of urinary retention in the hysterectomy group was double that of the non-hysterectomy group (26.5% vs. 13%, p = 0.01). Overall, a 10.1% rate of urinary tract infection was observed in patients discharged home with indwelling catheter. Urinary retention was not associated with age (years, 47 vs. 47.2, p = 0.92), menopausal status (26.6% vs. 33.1%, p = 0.284), BMI (kg/m2, 26.8 vs. 27.8, p = 0.23), perioperative opioid administration (morphine milligram equivalent, 11.8 vs. 9, p = 0.53), or EBL (mL, 56 vs. 46, p = 0.42). Operative time was longer in the retention group (minutes, 104 vs 93.7, p = 0.01). Hysterectomy appears to be an independent and major factor contributing to postoperative urinary retention. When compared to non-hysterectomy gynecologic surgeries with similar operative times, the rate of urinary retention in hysterectomy patients was doubled. These results may be helpful to the gynecologic surgeon when selecting appropriate candidates for postoperative void trial.View Large Image Figure ViewerDownload Hi-res image Download (PPT)