Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach

Postoperative urinary retention has been reported in 13-32% of patients that undergo pelvic organ prolapse (POP) repair. The purpose of our study was to compare rates of urinary retention between transvaginal and robotic transabdominal approaches and identify risk factors for postoperative urinary retention following POP repair.

Medical records of patients that underwent POP repair were reviewed. Surgeries included transvaginal high uterosacral ligament suspension (HUSLS) and robotic-assisted sacral colpopexy (RASCP). All patients underwent a retrograde fill voiding trial (RGVT) postoperatively. Demographics, comorbidities, preoperative urodynamic findings, and surgical procedures were compared between women that passed their RGVT and those that did not.

Out of 484 patients reviewed, 333 underwent POP repair with a transvaginal HUSLS and 151 underwent RASCP. Postoperative urinary retention was identified in 128 (26.4%) patients where 113 underwent transvaginal HUSLS and 15 underwent RASCP. The odds ratio (OR) of postoperative urinary retention following transvaginal HUSLS was 3.26 (CI 1.72-6.18; P < 0.001) compared to RASCP. Older age was also a risk factor for postoperative urinary retention (OR 1.03, CI 1.01-1.05; P = 0.012). While parity, preoperative post-void residual (PVR), and rates of concomitant transvaginal anterior/posterior repair were significantly higher in patients that developed postoperative urinary retention on univariate analysis, these factors did not demonstrate significance on multivariate analysis.

Transvaginal HUSLS demonstrates a 3.26 OR for postoperative urinary retention compared to the robotic transabdominal approach. Older age is also a significant risk factor whereas parity, preoperative PVR, and rates of concomitant transvaginal anterior/posterior repair were not significant risk factors on multivariate analysis.