Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland.
Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland.
Int Urogynecol J. 2022 Jun;33(6):1601-1608. doi: 10.1007/s00192-021-05074-5. Epub 2022 Feb 7.
Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed.
In our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed.
Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR.
In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.
产后尿潴留（PUR）可能导致长期的泌尿生殖系统疾病。其发病率在 0.18%至 14.6%之间，但及时诊断和适当处理的重要性往往被低估。PUR 后长期结局的数据不足导致了这些缺陷。本研究旨在评估 PUR 后残余尿量（PVR）升高的长期持续情况。我们回顾了 PUR 的发病机制、危险因素和处理方法。
在瑞士伯尔尼大学妇女医院的三级转诊泌尿科，所有因 PUR 而就诊的患者均被要求参与本研究。PVR 每 2 天用超声测量一次，直到第 15 天，然后在第 6、12、24 和 36 个月时进行测量，如果仍有增加，则指导患者进行清洁间歇性自家导尿。如果潴留持续时间超过哺乳期，则进行多通道尿动力学检查。
共纳入 62 例患者。PVR 中位数在第 7 天恢复正常。1、2 和 3 年后分别有 8.2%、6.7%和 4.9%的患者出现长期排尿障碍。在所有持续潴留的患者中，多通道尿动力学检查均证实为逼尿肌无收缩，4 例新出现压力性尿失禁。分位数回归未发现任何有助于早期恢复的因素。89%的 PUR 患者有经阴道分娩史，这强调了该危险因素对 PUR 的重要性。
在大多数情况下，PUR 会早期缓解，但排尿困难比以前认为的更为常见，对于这些患者，后果是灾难性的。产科意识、早期积极管理以及在产后期间制定管理策略可能会避免下尿路疾病。
