Abstract
We investigated whether implementation of a routine catheterization procedure in labor improves covert postpartum urinary retention (cPUR) rates. We conducted a prospective before-after study. 121 women admitted to delivery room in the observational group, and 82 in the intervention group, in a tertiary university hospital in Southern France were included. All patients in the intervention group were systematically catheterized 2 hours after delivery. cPUR was screened for in both groups. The primary end-point was cPUR (post-void residual bladder volume >150 ml when voided volume is >150 mL). The rate of cPUR decreased from 50% (60 out of 121 patients) in the observational group to 17% (14/82) in the intervention group (OR = 0.21; 95% Confidence Interval [0.13;0.58]; p < 0.001). Similarly, in the subgroup of patients who underwent instrumental delivery, the rate of cPUR was lower in the intervention group (18%, 2/11) than in the observational group (65%, 15/23) (p = 0.02). Systematic intermittent bladder catheterization immediately postpartum could decrease cPUR. Further studies are necessary to assess the long-term outcomes and improve understanding of postpartum voiding dysfunction.
Highlights
Certain urogynecological functions such as urinary continence, fecal continence and bladder emptying are adversely affected immediately postpartum, yet these functions are rarely evaluated at this time[1,2]
In a recent prospective descriptive study conducted in our hospital, we found a high rate of covert postpartum urinary retention (cPUR) of 52%, associated with risk factors identified in previous studies[16]: total labor length, duration at complete dilatation and instrumental delivery[17]
We found similar prognostic factors, with duration at complete dilatation, total labor duration and instrumental delivery associated with cPUR occurrence[15]
Summary
Certain urogynecological functions such as urinary continence, fecal continence and bladder emptying are adversely affected immediately postpartum, yet these functions are rarely evaluated at this time[1,2]. There is no epidemiologic study on prevalence of PVR in non-pregnant young women. Long-term consequences of cPUR were not investigated in older studies and comparisons against control groups of patients with normal voiding functions were not carried out[11]. One study found 2 women with persistent PUR necessitating self-catheterization at home in a group of 114 cPUR patients[12], whilst a retrospective study highlighted the occurrence of stress urinary incontinence and bladder overactivity in 50% of cases of persistent PUR13. Follow-up until 39 months of 55 women with persistent PUR confirmed rates of 10.4% of stress urinary incontinence, 8.3% of overactive bladder syndrome and 6.3% of subjective urinary symptoms[14]. Screening and management for cPUR might prevent persistent PUR, long-term bladder catheterization and persistent voiding dysfunction. As noted by the authors of a meta-analysis, current data on cPUR is confused by the heterogeneity in the methodology of the included studies, including inclusion criteria, length and type of follow-up, and distinction between oPUR and cPUR, further research has been encouraged, maintaining a homogeneity of definitions[15,16]
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