Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
Center for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Neurourol Urodyn. 2021 Jun;40(5):1182-1191. doi: 10.1002/nau.24676. Epub 2021 Apr 23.
Postoperative urinary retention (POUR) is a common complication of urogynecological surgery. Our study aimed to identify demographic and perioperative risk factors to construct a prediction model for POUR in urogynecology.
Our retrospective cohort study reviewed all patients undergoing pelvic reconstructive surgeries at our tertiary care center (Jan 1, 2013-May 1, 2019). Demographic, pre-, intra- and postoperative variables were collected from medical records. The primary outcome, POUR, was defined as (1) early POUR (E-POUR), failing initial trial of void or; (2) late POUR (L-POUR), requiring an indwelling catheter or intermittent catheterization on discharge. Risk factors were identified through univariate and multivariate logistic regression analyses. A clinical prediction model was constructed with the most significant and clinically relevant risk factors.
In 501 women, 182 (36.3%) had E-POUR and 61 of these women (12.2% of the entire cohort) had L-POUR. Multivariate logistic regression revealed preoperative postvoid residual (PVR) over 200 ml (odds ratio [OR]: 3.17; p = 0.026), voiding dysfunction symptoms extracted from validated questionnaires (OR: 3.00; p = 0.030), and number of concomitant procedures (OR: 1.30 per procedure; p = 0.021) as significant predictors of E-POUR; preoperative PVR more than 200 ml (OR: 4.07; p = 0.011) and antiincontinence procedure with (OR: 3.34; p = 0.023) and without (OR: 2.64; p = 0.019) concomitant prolapse repair as significant predictors of L-POUR. A prediction model (area under the curve: 0.70) was developed for E-POUR.
Elevated preoperative PVR is the most significant risk factor for POUR. Alongside other risk factors, our prediction model for POUR can be used for patient counseling and surgical planning in urogynecologic surgery.
术后尿潴留（POUR）是妇科泌尿手术的常见并发症。本研究旨在确定人口统计学和围手术期危险因素，以构建妇科泌尿学 POUR 的预测模型。
我们的回顾性队列研究回顾了 2013 年 1 月 1 日至 2019 年 5 月 1 日在我们的三级护理中心接受盆腔重建手术的所有患者。从病历中收集人口统计学、术前、术中及术后变量。主要结局为 POUR，定义为（1）早期 POUR（E-POUR），即初始排尿试验失败；（2）晚期 POUR（L-POUR），即出院时需要留置导尿管或间歇性导尿。通过单变量和多变量逻辑回归分析确定危险因素。利用最显著和最相关的危险因素构建临床预测模型。
在 501 名女性中，182 名（36.3%）发生 E-POUR，其中 61 名（整个队列的 12.2%）发生 L-POUR。多变量逻辑回归显示术前残余尿量（PVR）超过 200ml（优势比[OR]：3.17；p=0.026）、从经过验证的问卷中提取的排尿功能障碍症状（OR：3.00；p=0.030）和同时进行的手术数量（OR：每增加一个手术增加 1.30；p=0.021）是 E-POUR 的显著预测因素；术前 PVR 超过 200ml（OR：4.07；p=0.011）和抗失禁手术（OR：3.34；p=0.023）与同时进行（OR：2.64；p=0.019）和不进行（OR：2.64；p=0.019）脱垂修复是 L-POUR 的显著预测因素。还为 E-POUR 开发了一个预测模型（曲线下面积：0.70）。
术前 PVR 升高是 POUR 的最重要危险因素。结合其他危险因素，我们的 POUR 预测模型可用于妇科泌尿手术中的患者咨询和手术计划。
