International Urogynecology Journal

, Volume 25, Issue 12, pp 1605–1612 | Cite as

Postpartum urinary retention: a systematic review of adverse effects and management

  • F. E. M. Mulder
  • R. A. Hakvoort
  • M. A. Schoffelmeer
  • J. Limpens
  • J. A. M. Van der Post
  • J. P. W. R. Roovers
Review Article
First Online:
Received:
Accepted:

Abstract

Introduction and hypothesis

Postpartum urinary retention (PUR) is a well-known condition after childbirth. Often clinicians assume that this condition is transient, either through belief or by not being aware that its occurrence as measurement of post-void residual volume (PVRV) is often not routine. However, long lasting urinary retention is a serious condition that needs management in order to prevent urogenital tract morbidity. By performing a systematic review of the adverse effects of PUR and management of this condition, we aimed to identify the necessity of diagnosing this condition in the puerperium and to evaluate whether treatment is required.

Methods

We searched for all studies on PUR in OVID MEDLINE, OVID EMBASE, and ongoing Trial registers. Two reviewers independently screened and extracted the data.

Results

Twenty-four papers were included in this review. Limited data on adverse effects demonstrate potential morbidities, like micturition symptoms and sporadically spontaneous bladder ruptures, related to PUR.

Conclusions

Based on current literature, evidence stating that PUR is harmless is lacking. Future research should focus on management strategies for overt PUR and the long-term consequences of covert PUR. Until these results are available, clinicians should be aware of the potential consequences and therefore keep trying to identify patients at risk of PUR and patients with the actual condition.

Keywords

Postpartum Urinary retention Voiding dysfunctions Bladder dysfunction Post-void residual volume (PVRV) Adverse effects 

Abbreviations

PUR

Postpartum urinary retention

PVRV

Post-void residual volume

CIC

Clean intermittent catheterization

This is a preview of subscription content, log in to check access.

Notes

Conflicts of interest

None.

References

  1. 1.
    Yip SK, Brieger G, Hin LY, Chung T (1997) Urinary retention in the post-partum period. The relationship between obstetric factors and the post-partum post-void residual bladder volume. Acta Obstet Gynecol Scand 76:667–672PubMedCrossRefGoogle Scholar
  2. 2.
    Andolf E, Iosif CS, Jorgensen C, Rydhstrom H (1994) Insidious urinary retention after vaginal delivery: prevalence and symptoms at follow-up in a population-based study. Gynecol Obstet Investig 38:51–53CrossRefGoogle Scholar
  3. 3.
    Hee P, Lose G, Beier-Holgersen R, Engdahl E, Falkenlove P (1992) Postpartum voiding in the primiparous after vaginal delivery. Int Urogynecol J 3:95–99CrossRefGoogle Scholar
  4. 4.
    Kekre AN, Vijayanand S, Dasgupta R, Kekre N (2011) Postpartum urinary retention after vaginal delivery. Int J Gynaecol Obstet 112:112–115PubMedCrossRefGoogle Scholar
  5. 5.
    Glavind K, Bjork J (2003) Incidence and treatment of urinary retention postpartum. Int Urogynecol J Pelvic Floor Dysfunct 14:119–121PubMedCrossRefGoogle Scholar
  6. 6.
    Ching-Chung L, Shuenn-Dhy C, Ling-Hong T, Ching-Chang H, Chao-Lun C, Po-Jen C (2002) Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Aust N Z J Obstet Gynaecol 42:365–368PubMedCrossRefGoogle Scholar
  7. 7.
    Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ (2007) Postpartum urinary retention after cesarean delivery. Int J Gynaecol Obstet 99:229–232PubMedCrossRefGoogle Scholar
  8. 8.
    Rizvi RM, Khan ZS, Khan Z (2005) Diagnosis and management of postpartum urinary retention. Int J Gynaecol Obstet 91:71–72PubMedCrossRefGoogle Scholar
  9. 9.
    Hakvoort RA, Dijkgraaf MG, Burger MP, Emanuel MH, Roovers JP (2009) Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn 28:225–228PubMedCrossRefGoogle Scholar
  10. 10.
    Fitzgerald MP, Kulkarni N, Fenner D (2000) Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse. Am J Obstet Gynecol 183:1361–1363PubMedCrossRefGoogle Scholar
  11. 11.
    Sokol AI, Jelovsek JE, Walters MD, Paraiso MF, Barber MD (2005) Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery. Am J Obstet Gynecol 192:1537–1543PubMedCrossRefGoogle Scholar
  12. 12.
    Smorgick N, DeLancey J, Patzkowsky K, Advincula A, Song A, As-Sanie S (2012) Risk factors for postoperative urinary retention after laparoscopic and robotic hysterectomy for benign indications. Obstet Gynecol 120:581–586PubMedCrossRefGoogle Scholar
  13. 13.
    Stallard S, Prescott S (1988) Postoperative urinary retention in general surgical patients. Br J Surg 75:1141–1143PubMedCrossRefGoogle Scholar
  14. 14.
    Mustonen S, Ala-Houhala IO, Tammela TL (2001) Long-term renal dysfunction in patients with acute urinary retention. Scand J Urol Nephrol 35:44–48PubMedCrossRefGoogle Scholar
  15. 15.
    Mustonen S, Ala-Houhala IO, Turjanmaa V, Tammela TL (2001) Effect of acute urinary retention on glomerular filtration rate. Clin Nephrol 56:81–82PubMedGoogle Scholar
  16. 16.
    Abe T, Shinno Y, Kawakura K, Moriya K (2000) Acute renal failure occurring from urinary retention due to a mullerian duct cyst. Int J Urol 7:69–71PubMedCrossRefGoogle Scholar
  17. 17.
    Lewis JM, Yalla SV, Stanitski KE, Sullivan MP (2012) Spectrum of urodynamic abnormalities and renal function changes in adult men with non-neurogenic urinary retention. Neurourol Urodyn 31:544–548PubMedCrossRefGoogle Scholar
  18. 18.
    Bross S, Schumacher S, Scheepe JR, Zendler S, Braun PM, Alken P, Junemann K (1999) Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation. Eur Urol 36:354–359PubMedCrossRefGoogle Scholar
  19. 19.
    Madersbacher H, Cardozo L, Chapple C, Abrams P, Toozs-Hobson P, Young JS, Wyndaele JJ, De WS, Campeau L, Gajewski JB (2012) What are the causes and consequences of bladder overdistension? ICI-RS 2011. Neurourol Urodyn 31:317–321PubMedCrossRefGoogle Scholar
  20. 20.
    Muellner S (1938) Physiological bladder changes during pregnancy and the puerperium. J Urol 41:691Google Scholar
  21. 21.
    Iosif S, Ingemarsson I, Ulmsten U (1980) Urodynamic studies in normal pregnancy and in puerperium. Am J Obstet Gynecol 137:696–700PubMedGoogle Scholar
  22. 22.
    Snooks SJ, Swash M, Mathers SE, Henry MM (1990) Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg 77:1358–1360PubMedCrossRefGoogle Scholar
  23. 23.
    Liang CC, Lin YH, Chen TC, Chang SD (2014) How antepartum and postpartum acute urinary retention affects the function and structure of the rat bladder. Int Urogynecol J doi: 10.1007/s00192-013-2320-7 Google Scholar
  24. 24.
    Zaki MM, Pandit M, Jackson S (2004) National survey for intrapartum and postpartum bladder care: assessing the need for guidelines. BJOG 111:874–876PubMedCrossRefGoogle Scholar
  25. 25.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34PubMedCrossRefGoogle Scholar
  26. 26.
    Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349CrossRefGoogle Scholar
  27. 27.
    Olofsson CI, Ekblom AO, Ekman-Ordeberg GE, Irestedt LE (1997) Post-partum urinary retention: a comparison between two methods of epidural analgesia. Eur J Obstet Gynecol Reprod Biol 71:31–34PubMedCrossRefGoogle Scholar
  28. 28.
    Foon R, Toozs-Hobson P, Millns P, Kilby M (2010) The impact of anesthesia and mode of delivery on the urinary bladder in the postdelivery period. Int J Gynaecol Obstet 110:114–117PubMedCrossRefGoogle Scholar
  29. 29.
    Liang CC, Chang SD, Wong SY, Chang YL, Cheng PJ (2010) Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean delivery. J Obstet Gynaecol Res 36:991–995PubMedCrossRefGoogle Scholar
  30. 30.
    Lee J (1961) Management of postpartum urinary retention. Obstet Gynecol 17:464–471PubMedGoogle Scholar
  31. 31.
    Sherline DM, DANFORTH DN (1962) Effects of labor, delivery, and anesthesia on postpartum bladder function. Obstet Gynecol 19:808–813PubMedGoogle Scholar
  32. 32.
    Teo R, Punter J, Abrams K, Mayne C, Tincello D (2007) Clinically overt postpartum urinary retention after vaginal delivery: a retrospective case–control study. Int Urogynecol J Pelvic Floor Dysfunct 18:521–524PubMedCrossRefGoogle Scholar
  33. 33.
    Fedorkow DM, Drutz HP, Mainprize TC (1990) Characteristics of patients with postpartum urinary retention. Int Urogynecol J 1:136–138CrossRefGoogle Scholar
  34. 34.
    Carley ME, Carley JM, Vasdev G, Lesnick TG, Webb MJ, Ramin KD, Lee RA (2002) Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. Am J Obstet Gynecol 187:430–433PubMedCrossRefGoogle Scholar
  35. 35.
    Musselwhite KL, Faris P, Moore K, Berci D, King KM (2007) Use of epidural anesthesia and the risk of acute postpartum urinary retention. Am J Obstet Gynecol 196:472–475PubMedCrossRefGoogle Scholar
  36. 36.
    Buchanan J, Beckmann M (2014) Postpartum voiding dysfunction: identifying the risk factors. Aust N Z J Obstet Gynaecol 54:41–45PubMedCrossRefGoogle Scholar
  37. 37.
    Groutz A, Gordon D, Wolman I, Jaffa A, Kupferminc MJ, Lessing JB (2001) Persistent postpartum urinary retention in contemporary obstetric practice. Definition, prevalence and clinical implications. J Reprod Med 46:44–48PubMedGoogle Scholar
  38. 38.
    Groutz A, Levin I, Gold R, Pauzner D, Lessing JB, Gordon D (2011) Protracted postpartum urinary retention: the importance of early diagnosis and timely intervention. Neurourol Urodyn 30:83–86PubMedCrossRefGoogle Scholar
  39. 39.
    Humburg J, Holzgreve W, Hoesli I (2007) Prolonged postpartum urinary retention: the importance of asking the right questions at the right time. Gynecol Obstet Investig 64:69–71CrossRefGoogle Scholar
  40. 40.
    Chai AH, Wong T, Mak HL, Cheon C, Yip SK, Wong AS (2008) Prevalence and associated risk factors of retention of urine after caesarean section. Int Urogynecol J Pelvic Floor Dysfunct 19:537–542PubMedCrossRefGoogle Scholar
  41. 41.
    Weissman A, Grisaru D, Shenhav M, Peyser RM, Jaffa AJ (1995) Postpartum surveillance of urinary retention by ultrasonography: the effect of epidural analgesia. Ultrasound Obstet Gynecol 6:130–134PubMedCrossRefGoogle Scholar
  42. 42.
    Van Os AF, Van der Linden PJ (2006) Reliability of an automatic ultrasound system in the post partum period in measuring urinary retention. Acta Obstet Gynecol Scand 85:604–607PubMedCrossRefGoogle Scholar
  43. 43.
    Demaria F, Amar N, Biau D, Fritel X, Porcher R, Amarenco G, Madelenat P, Benifla JL (2004) Prospective 3D ultrasonographic evaluation of immediate postpartum urine retention volume in 100 women who delivered vaginally. Int Urogynecol J Pelvic Floor Dysfunct 15:281–285PubMedGoogle Scholar
  44. 44.
    Ismail SI, Emery SJ (2008) The prevalence of silent postpartum retention of urine in a heterogeneous cohort. J Obstet Gynaecol 28:504–507PubMedCrossRefGoogle Scholar
  45. 45.
    Ramsay IN, Torbet TE (1993) Incidence of abnormal voiding parameters in the immediate postpartum period. Neurourol Urodyn 12:179–183PubMedCrossRefGoogle Scholar
  46. 46.
    Lee SN, Lee CP, Tang OS, Wong WM (1999) Postpartum urinary retention. Int J Gynaecol Obstet 66:287–288PubMedCrossRefGoogle Scholar
  47. 47.
    Liang CC, Wong SY, Tsay PT, Chang SD, Tseng LH, Wang MF, Soong YK (2002) The effect of epidural analgesia on postpartum urinary retention in women who deliver vaginally. Int J Obstet Anesth 11:164–169PubMedCrossRefGoogle Scholar
  48. 48.
    Yip SK, Sahota D, Chang AM, Chung TK (2002) Four-year follow-up of women who were diagnosed to have postpartum urinary retention. Am J Obstet Gynecol 187:648–652PubMedCrossRefGoogle Scholar
  49. 49.
    Jeffery TJ, Thyer B, Tsokos N, Taylor JD (1990) Chronic urinary retention postpartum. Aust N Z J Obstet Gynaecol 30:364–366PubMedCrossRefGoogle Scholar
  50. 50.
    Humburg J, Troeger C, Holzgreve W, Hoesli I (2011) Risk factors in prolonged postpartum urinary retention: an analysis of six cases. Arch Gynecol Obstet 283:179–183PubMedCrossRefGoogle Scholar
  51. 51.
    Watson WJ (1991) Prolonged postpartum urinary retention. Mil Med 156:502–503PubMedGoogle Scholar
  52. 52.
    Duenas-Garcia OF, Rico H, Gorbea-Sanchez V, Herrerias-Canedo T (2008) Bladder rupture caused by postpartum urinary retention. Obstet Gynecol 112:481–482PubMedCrossRefGoogle Scholar
  53. 53.
    Gaikwad PR, Sharma S, Kanitkar SV, Kachane T (2011) Spontaneous rupture of the urinary bladder in the puerperium. J Obstet Gynecol India 61:208–209CrossRefGoogle Scholar
  54. 54.
    Png KS, Chong YL, Ng CK (2008) Two cases of intraperitoneal bladder rupture following vaginal delivery. Singapore Med J 49:327–329Google Scholar
  55. 55.
    Roberts C, Oligbo N, Swinhoe J (1996) Spontaneous bladder rupture following normal vaginal delivery: a postpartum emergency. Br J Obstet Gynaecol 103:381–382PubMedCrossRefGoogle Scholar
  56. 56.
    Kekre AN, Kekre N, Nath V, Seshadri L (1997) Spontaneous rupture of the urinary bladder in the puerperium. Aust N Z J Obstet Gynaecol 37:473–474PubMedCrossRefGoogle Scholar
  57. 57.
    Wandabwa J, Otim T, Kiondo P (2004) Spontaneous rupture of bladder in puerperium. Afr Health Sci 4:138–139PubMedCentralPubMedGoogle Scholar
  58. 58.
    Mulder F, Schoffelmeer M, Hakvoort R, Limpens J, Mol B, van der Post J, Roovers J (2012) Risk factors for postpartum urinary retention: a systematic review and meta-analysis. BJOG 119:1440–1446PubMedCrossRefGoogle Scholar
  59. 59.
    Yip SK, Sahota D, Pang MW, Day L (2005) Postpartum urinary retention. Obstet Gynecol 106:602–606PubMedCrossRefGoogle Scholar
  60. 60.
    Niel-Weise BS, van den Broek PJ (2005) Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev 7:CD004203Google Scholar
  61. 61.
    Hakvoort R, Thijs S, Bouwmeester F, Broekman A, Ruhe I, Vernooij M, Burger M, Emanuel M, Roovers J (2011) Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG 118:1055–1060PubMedCrossRefGoogle Scholar
  62. 62.
    Evron S, Dimitrochenko V, Khazin V, Sherman A, Sadan O, Boaz M, Ezri T (2008) The effect of intermittent versus continuous bladder catheterization on labor duration and postpartum urinary retention and infection: a randomized trial. J Clin Anesth 20:567–572PubMedCrossRefGoogle Scholar
  63. 63.
    Millet L, Shaha S, Bartholomew ML (2012) Rates of bacteriuria in laboring women with epidural analgesia: continuous vs intermittent bladder catheterization. Am J Obstet Gynecol 206:316–317PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • F. E. M. Mulder
    • 1
  • R. A. Hakvoort
    • 2
  • M. A. Schoffelmeer
    • 1
  • J. Limpens
    • 3
  • J. A. M. Van der Post
    • 1
  • J. P. W. R. Roovers
    • 1
  1. 1.Department of Obstetrics and GynaecologyAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Department of Obstetrics and GynaecologySpaarne HospitalHoofddorpThe Netherlands
  3. 3.Medical LibraryAcademic Medical CentreAmsterdamThe Netherlands

Personalised recommendations