Predictors of length of stay after urogynecological surgery at a tertiary referral center

Systematic review and meta-analysis of the pelvic organ prolapse and vaginal prolapse among the global population

Background

Pelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, bowel, bladder or top of the vagina) descend from their normal position and bulge into the vagina. Symptoms include pelvic discomfort, fullness, and changes in bladder or bowel function. Treatment ranges from conservative approaches to surgery, depending on symptom severity. Surgical methods include vaginal wall repair, with or without hysterectomy, or via laparoscopic, robotic or open techniques. Common complications include bleeding, infection, and urinary or bowel dysfunction.

Methods

A systematic review was conducted, and a protocol was registered with PROSPERO (CRD42022346051). Publications from 30 April 1980 to 30 April 2023 were retrieved from multiple databases. Data were analysed using random-effects and common-effects models with subgroup and sensitivity analyses.

Findings

Forty-four studies met the inclusion criteria, with 29 studies used for meta-analysis of vaginal prolapse surgery outcomes. Sixteen studies focused on patients who had undergone hysterectomy alongside prolapse repair.

Interpretation

Patients who underwent vaginal prolapse surgery with hysterectomy experienced higher operative and postoperative complication rates than those without hysterectomy. Increased risks included hospital readmission, POP recurrence and re-operation. The review highlighted a lack of diversity in terms of ethnicity, age and comorbidity status, which are essential to fully understanding the impact of POP. Future research should focus on these underrepresented factors.

Development and validation of a prediction model for postoperative urinary retention after prolapse surgery: A retrospective cohort study

BACKGROUND

Postoperative urinary retention (POUR), a common condition after prolapse surgery with potential serious sequelae if left untreated, lacks a clearly established optimal timing for catheter removal. This study aimed to develop and validate a predictive model for postoperative urinary retention lasting > 2 and > 4 days after prolapse surgery.

METHODS

We conducted a retrospective review of 1,122 patients undergoing prolapse surgery. The dataset was divided into training and testing cohorts. POUR was defined as the need for continuous intermittent catheterization resulting from a failed spontaneous voiding trial, with passing defined as two consecutive voids ≥ 150 mL and a postvoid residual urine volume ≤ 150 mL. We performed logistic regression and the predicted model was validated using both training and testing cohorts.

RESULTS

Among patients, 31% and 12% experienced POUR lasting > 2 and > 4 days, respectively. Multivariable logistic model identified 6 predictors. For predicting POUR, internal validation using cross-validation approach showed good performance, with accuracy lasting > 2 (area under the curve [AUC] 0.73) and > 4 days (AUC 0.75). Split validation using pre-separated dataset also showed good performance, with accuracy lasting > 2 (AUC 0.73) and > 4 days (AUC 0.74). Calibration curves demonstrated that the model accurately predicted POUR lasting > 2 and > 4 days (from 0 to 80%).

CONCLUSIONS

The proposed prediction model can assist clinicians in personalizing postoperative bladder care for patients undergoing prolapse surgery by providing accurate individual risk estimates.

Risk factors for urinary retention after urogynecologic surgery: A retrospective cohort study and prediction model

AIMS

Postoperative urinary retention (POUR) is a common complication of urogynecological surgery. Our study aimed to identify demographic and perioperative risk factors to construct a prediction model for POUR in urogynecology.

METHODS

Our retrospective cohort study reviewed all patients undergoing pelvic reconstructive surgeries at our tertiary care center (Jan 1, 2013-May 1, 2019). Demographic, pre-, intra- and postoperative variables were collected from medical records. The primary outcome, POUR, was defined as (1) early POUR (E-POUR), failing initial trial of void or; (2) late POUR (L-POUR), requiring an indwelling catheter or intermittent catheterization on discharge. Risk factors were identified through univariate and multivariate logistic regression analyses. A clinical prediction model was constructed with the most significant and clinically relevant risk factors.

RESULTS

In 501 women, 182 (36.3%) had E-POUR and 61 of these women (12.2% of the entire cohort) had L-POUR. Multivariate logistic regression revealed preoperative postvoid residual (PVR) over 200 ml (odds ratio [OR]: 3.17; p = 0.026), voiding dysfunction symptoms extracted from validated questionnaires (OR: 3.00; p = 0.030), and number of concomitant procedures (OR: 1.30 per procedure; p = 0.021) as significant predictors of E-POUR; preoperative PVR more than 200 ml (OR: 4.07; p = 0.011) and antiincontinence procedure with (OR: 3.34; p = 0.023) and without (OR: 2.64; p = 0.019) concomitant prolapse repair as significant predictors of L-POUR. A prediction model (area under the curve: 0.70) was developed for E-POUR.

CONCLUSIONS

Elevated preoperative PVR is the most significant risk factor for POUR. Alongside other risk factors, our prediction model for POUR can be used for patient counseling and surgical planning in urogynecologic surgery.