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Post void residual urine in female12/30/2023 ![]() ![]() Although long-term consequences of PUR are rarely reported and small studies showed negligible if any clinical impact on long-term urogynecological disorders, only a few data are available on the potential long-term micturition problems of increased PVR after vaginal delivery. PUR can lead to denervation, detrusor atony, and bladder dysfunction if it is not recognized in time. Trauma to the pelvic floor muscles, the detrusor muscle itself, and overdistention of nerve fibers might impair bladder sensitivity, cause periurethral obstructing edema, and hormonal changes may influence bladder function as well. Levator ani muscle avulsion seems to be associated with persistent postpartum voiding dysfunction, but the etiology of PUR is thought to be multifactorial. Several theories have been suggested, including physiological, neurological, and mechanical processes during pregnancy and delivery. The pathophysiology of PUR is poorly understood. The incidence of PUR ranges from 0.18 to 47% depending on the varying definitions and the time interval of follow-up used. Overt PUR has been defined as the inability to void within 6 h of delivery or after removal of the catheter, whereas covert PUR means an increased post-void residual urine volume (PVR) of more than 150 ml after spontaneous micturition. Postpartum urinary retention (PUR) is a serious and frequent complication after childbirth. ![]() Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity. In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. Quantile regression did not reveal any factor contributing to earlier recovery. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. ![]() Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. If retention persisted longer than the lactation period, multichannel urodynamics was performed. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. In our tertiary referral urogynecology unit in the University Women’s Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. Pathophysiology, risk factors and management of PUR are reviewed. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. ![]()
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