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

This study aimed to identify clinical and bladder-related factors associated with persistent postpartum urinary retention (PUR), with particular emphasis on bladder sensation and bladder overdistension.

This retrospective cohort study included 31 women diagnosed with PUR following vaginal or cesarean delivery. Persistent PUR was defined as catheterization lasting more than 7 days (168 h). Clinical and bladder-related variables were compared between patients with persistent and nonpersistent PUR. Univariable and multivariable associations were evaluated using Firth's penalized logistic regression. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative performance of initial catheterized urine volume.

Of the 31 patients in this study, 12 (38.7%) developed persistent PUR. In univariable Firth logistic regression, absent bladder sensation (OR 51.92, 95% CI 5.34-7,045.45, p < 0.001), epidural anesthesia (OR 12.78, 95% CI 2.30-135.91, p = 0.002), and an initial catheterized urine volume ≥1,200 mL (OR 10.37, 95% CI 1.88-109.54, p = 0.006) were significantly associated with persistent PUR. After multivariable adjustment, absent bladder sensation showed a strong but nonsignificant association with persistent PUR (adjusted OR 30.12, 95% CI 0.76-11,223.39, p = 0.072), whereas epidural anesthesia and catheterized urine volume were not independently associated. ROC analysis demonstrated moderate discriminative ability of initial catheterized urine volume (AUC 0.68, 95% CI 0.49-0.88), with an optimal threshold of approximately 1,175 mL, yielding a sensitivity of 91.7% and a specificity of 57.9%.

Absent bladder sensation and bladder overdistension appear to be clinically relevant features of persistent PUR. Although these variables were not independent predictors after multivariable penalized regression, their strong univariable associations and biological plausibility support careful postpartum bladder monitoring and early prevention of bladder overdistension. Larger prospective studies are needed to validate these findings.