Incidences and risk factors of postoperative urinary retention after mid-urethral sling placement with and without pelvic reconstructive surgery

Objective: Postoperative urinary retention (POUR) is a common consequence of urogynecologic surgery. In this study, we retrospectively assessed the rate of POUR and identified risk factors for the development of urinary retention after mid-urethral sling placement with and without pelvic reconstructive surgery. Materials and methods: Eight hundred and sixty-six women with urodynamic stress incontinence who underwent transobturator (TOT) and single-incision sling (SIS) placement, with or without a concomitant reconstructive procedure, were included in this study. Postoperative evaluations from the study were reviewed both subjectively and objectively, including voiding volume and bladder scan prior to discharge, cough stress test, uroflowmetry, changes in urodynamic parameters, and the Urogenital Distress Inventory six-item questionnaire at 3 months after surgery. Results: A total of 866 patients were included, of which 686 patients had no POUR (79.2 %), 158 had transient POUR (18.3 %), and 22 had prolonged POUR (2.5 %). No patients with prolonged POUR required a Foley catheter 2 weeks after discharge. Prior pelvic reconstruction surgery, concomitant hysterectomy, older age, and higher postvoid residual volume were associated with POUR (p < 0.05). Incidences of POUR were not significantly different between patients with and without concomitant pelvic reconstructive surgery. However, patients with SIS had a higher incidence of POUR than those with TOT (p < 0.05). Total objective cure rate of urodynamic stress incontinence was 91.7 %. Patients with prolonged POUR had a significantly lower cure rate, whereas those with transient POUR had the highest cure rate (p 1/4 0.013). Multiple logistic regression analysis revealed that old age, previous hysterectomy, MUCP <30 cmH2O, and SIS were the risk factors for POUR. Conclusions: POUR was common after mid-urethral sling placement with or without pelvic reconstructive surgery; however, most cases were mild, transient and resolved spontaneously. Clinicians should be aware of the risk factors for POUR and strive for adequate prevention and management. (c) 2025 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).