Is hysterectomy a risk factor for urinary retention? A retrospective matched case control study

Abstract Study objective Compare rates of urinary retention in patients undergoing endoscopic hysterectomy with those undergoing non-hysterectomy endoscopic gynecologic surgery Design Retrospective case control study matched by operative time Setting Academic medical center Patients All patients undergoing endoscopic gynecologic surgeries between January 2013 and December 2018 Interventions Outpatient endoscopic gynecologic surgery Measurements and main results A total of 200 endoscopic hysterectomy cases were matched to endoscopic non-hysterectomy gynecologic surgery controls in a 1:1 ratio. Differences in baseline and operative characteristics between the two groups included age (years, 48.6 vs. 45.7, p = 0.04), perioperative opioid administration (morphine mg equivalents, 11.6 vs. 7.6, p = 0.01) and estimated blood loss (mL, 64.1 vs. 31.8, p=0.001). Rate of urinary retention in the hysterectomy group was double that of the non-hysterectomy group (26.5% vs. 13%, p = 0.01). In the hysterectomy group age, perioperative opioids, operative time, and estimated blood loss did not differ between those that failed or passed the void trial. In the non-hysterectomy group, only operative time was significantly longer in those that failed the void trial (mins, 108 vs. 94.3, p=0.04). After adjusting for perioperative opioid use and operative time, the relative risk of urinary retention in the hysterectomy group was 2.3 (p=0.002, 95% CI 1.38 – 3.98). Conclusion Hysterectomy appears to be an independent and major factor contributing to postoperative urinary retention. When compared to non-hysterectomy gynecologic surgical controls with similar operative times, the rate of urinary retention in hysterectomy patients was doubled.