Clinical Significance of Bladder Sensory Loss and Bladder Overdistension in Persistent Postpartum Urinary Retention

To explore clinical and bladder-related factors associated with postpartum urinary retention (PUR), with particular emphasis on bladder sensation and bladder overdistension.

This retrospective pilot cohort study included 30 women diagnosed with PUR following vaginal or cesarean delivery. PUR was defined as inability to void within 6 hours postpartum or elevated postvoid residual volume. Persistent PUR was defined as retention requiring catheterization beyond 7 days. Patients were classified into persistent and non-persistent groups. Clinical, obstetric, and bladder-related variables were compared. Multivariable logistic regression was performed in an exploratory manner to identify factors independently associated with persistent PUR.

Persistent PUR was observed in 18 patients (60%). Patients with persistent PUR more frequently had epidural anesthesia, longer second stage of labor, and delayed time to first void (all p < 0.05).Absent bladder sensation was strongly associated with persistent PUR (89% vs. 8%, p < 0.001). Initial catheterization volume was significantly higher in the persistent group (median 1400 vs. 1000 mL, p < 0.001).In exploratory multivariable analysis, absent bladder sensation (OR 32.5, 95% CI 5.2-180.4) and catheterization volume >1200 mL (OR 8.4, 95% CI 2.1-33.7) were independently associated with persistent PUR. Catheterization volume demonstrated good discriminative ability (AUC ≈ 0.83) and was positively correlated with time to recovery (r = 0.63, p < 0.001), supporting its clinical relevance.

Persistent PUR appears to be associated with impaired bladder sensation and bladder overdistension, supporting a combined neurogenic and myogenic pathophysiological mechanism. These findings highlight the importance of early postpartum bladder monitoring in preventing prolonged dysfunction.