Groutz A, Gordon D, Wolman I, Jaffa A, Kupferminc M J, Lessing J B
Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Reprod Med. 2001 Jan;46(1):44-8.
To prospectively evaluate the prevalence, presumed etiologies and clinical implications of persistent postpartum urinary retention in modern obstetric practice.
The study population comprised 8,402 consecutive, unselected parturients delivered in a university-affiliated maternity hospital over a one-year period. If a woman was unable to void spontaneously until the third postpartum day despite intermittent use of a Foley catheter, a diagnosis of persistent postpartum urinary retention was established. Patients were treated by insertion of a Foley catheter for up to two weeks and subsequently by a suprapubic catheter. Obstetric data were collected from the hospital records.
Four patients (0.05% of the study population), aged 29-37 years, developed persistent postpartum urinary retention. Risk factors included vaginal delivery after cesarean section, prolonged second stage of labor, epidural analgesia, and delayed diagnosis and intervention. Urodynamic evaluation, performed on two patients one month after removal of the suprapubic catheter, revealed genuine stress incontinence in one and detrusor instability in another. None had had any lower urinary tract symptoms before pregnancy and delivery.
Persistent postpartum urinary retention in contemporary obstetric practice is rare but may be associated with long-term bladder dysfunction. Early diagnosis and intervention are required to prevent irreversible bladder damage.
前瞻性评估现代产科实践中持续性产后尿潴留的患病率、推测病因及临床意义。
研究人群包括在一所大学附属医院一年内连续分娩的8402例未经选择的产妇。如果一名妇女尽管间歇性使用Foley导尿管，但直到产后第三天仍无法自主排尿，则诊断为持续性产后尿潴留。患者接受Foley导尿管插入治疗长达两周，随后接受耻骨上导管治疗。产科数据从医院记录中收集。
4例患者（占研究人群的0.05%），年龄29 - 37岁，发生持续性产后尿潴留。危险因素包括剖宫产术后阴道分娩、第二产程延长、硬膜外镇痛以及诊断和干预延迟。在拔除耻骨上导管一个月后，对两名患者进行了尿动力学评估，其中一名患者显示真性压力性尿失禁，另一名患者显示逼尿肌不稳定。所有患者在妊娠和分娩前均无任何下尿路症状。
当代产科实践中持续性产后尿潴留很少见，但可能与长期膀胱功能障碍有关。需要早期诊断和干预以防止不可逆的膀胱损伤。
