Nomogram to Predict Risk of Postoperative Urinary Retention in Women Undergoing Pelvic Reconstructive Surgery

Area of Science:

• Urogynecology
• Surgical Oncology
• Medical Nomograms

Background:

• Postoperative urinary retention (POUR) is a common complication following pelvic floor reconstructive surgery.
• Accurate prediction of POUR risk is essential for effective patient management and preoperative counseling.
• Existing predictive models for POUR following these specific procedures are limited.

Purpose of the Study:

• To develop and validate a predictive nomogram for estimating the risk of postoperative urinary retention (POUR).
• To identify key pre- and intraoperative risk factors associated with POUR after pelvic floor reconstructive surgery.
• To provide a clinical tool for quantifying individual patient risk of POUR.

Main Methods:

• Retrospective chart review of women undergoing pelvic organ prolapse and/or stress urinary incontinence surgery.
• Definition of short-term POUR: failure of trial of void or need for re-catheterization within 48 hours post-surgery.
• Multivariate binary logistic regression with best-subsets variable selection to construct the predictive nomogram.

Main Results:

• Overall incidence of POUR was 31% (103 of 332 patients).
• Significant risk factors identified for POUR included diabetes, multiple medical comorbidities, laparoscopic sling procedure, anterior vaginal repair, laparoscopic colposacropexy, and vaginal hysterectomy.
• The developed nomogram provides a risk stratification for POUR ranging from less than 10% to over 80%.

Conclusions:

• A predictive nomogram can effectively estimate POUR risk based on clinical characteristics and surgical procedures.
• The nomogram facilitates personalized preoperative patient counseling regarding POUR risk.
• While developed from a single surgeon's series, the model shows potential for guiding clinical decision-making.