Guarding Reflex Inhibition Training Reduces Postoperative Urinary Retention After Urethral Bulking for Stress Urinary...

Background/Objectives: Postoperative urinary retention (POUR) occurs in 10-15% of women after surgical procedures for stress urinary incontinence (SUI). Guarding Reflex Inhibition Training (GRIT) is a novel behavioral approach that teaches patients to consciously inhibit involuntary pelvic floor contraction. We evaluated whether preoperative GRIT is associated with decreased POUR after urethral bulking with polyacrylamide hydrogel (PAHG). Methods: We performed a retrospective review of 145 women with SUI. Perioperative care was consistent across groups, separated by date of service; only those treated after November 2023 received structured GRIT instruction. The primary outcome was POUR, defined as the need for >1 episode of straight catheterization or discharge with a catheter. Results: POUR occurred in 15/106 (14.2%) patients without GRIT and 0/39 (0%) patients with GRIT. This difference was statistically significant (Fisher's exact test p = 0.012), corresponding to an absolute risk reduction of 14.2% (95% CI: 4.8-23.9) and a number needed to treat (NNT) of 7. Post hoc power was >90%. Conclusions: Preoperative GRIT, a novel and reproducible training paradigm, was associated with a reduction in POUR following urethral bulking. By targeting conscious inhibition of the guarding reflex, GRIT highlights the potential for integrating behavioral retraining with procedural therapy across incontinence interventions.