Evaluation of lower urinary tract symptoms in postpartum women: A nested case-control study

This paper examines the incidence, risk factors, and clinical variables of lower urinary tract symptoms (LUTS) following vaginal delivery and evaluates the diagnostic accuracy of urethral angles and bladder neck descent (BND) in stress urinary incontinence using two dimensional (2D) transperineal ultrasoufnd.

Four hundred and eight low-risk women at ≥37 weeks gestation undergoing vaginal delivery were recruited. On day 2 postpartum, the ICIQ-FLUTS questionnaire was applied for presence of urinary symptoms. Cases were defined as women having LUTS on day 2 postpartum (n = 82). An equal number of controls were taken from the cohort without LUTS as per nested case-control study design (n = 82). At 6 weeks, subjects were re-evaluated for resolution or persistence of urinary symptoms. In addition, Pelvic Floor Distress Inventory 20 (PFDI 20) score and Oxford grading were performed for pelvic floor dysfunction. 2D transperineal ultrasound was performed to compare the pubourethral angle (α), the posterior urethrovesical angle (β) at rest, and Valsalva.

Incidence of LUTS on day 2 postpartum was 20.1%, nocturia being the most common symptom. Approximately 43% of these subjects reported persistence of symptoms at 6 weeks. Multivariate logistic regression analysis revealed prolonged second stage of labor (odds ratio [OR], 1.054; P = <0.001) and higher birth weight (OR, 3.132; P = 0.026) as risk factors. Cutoffs obtained for Rα, Rβ, and BND were >10°, >13°, and 12 mm, respectively, with almost equal accuracy in diagnosing stress urinary incontinence and posterior urethrovesical rotation angle (Rβ) being the best predictor.

Incidence of LUTS postpartum is high and urinary symptoms might persist for several weeks after vaginal delivery. Careful attention in the postnatal clinics, counseling, appropriate management, and follow-up should be offered.