Risk factors for postoperative urinary retention after laparoscopic and robotic hysterectomy for benign indications.
OBJECTIVE
To estimate the occurrence of postoperative urinary retention after traditional laparoscopic and robotic hysterectomy.


METHODS
We performed a chart review of all patients who underwent total or supracervical hysterectomy using a laparoscopic (n=253) or robotic approach (n=281) from March 2001 until June 2010 for benign indications at the division for minimally invasive surgery. Urinary retention was defined as the inability to spontaneously void or as incomplete voiding requiring either self-catheterization or Foley catheter replacement in the first postoperative week.


RESULTS
Urinary retention occurred in 7.3% (95% confidence interval [CI] 5.2-9.8%) of women and was more than twice as common among women who underwent robotic hysterectomy compared with laparoscopic hysterectomy (10.3%, 95% CI 7.0-14.5% compared with 4.0%, 95% CI 1.9-7.1%, P=.005). No statistically significant differences in those with and without urinary retention were seen in age, body mass index, smoking status, number of prior cesarean deliveries, operative time, presence of severe adhesions, or findings of endometriosis. In a multivariable logistic regression analysis, only the robotic approach relative to traditional laparoscopic approach was found to be significantly associated with urinary retention (odds ratio 2.6, 95% CI 1.2-5.6). Postoperative urinary retention was associated with a higher incidence of lower urinary tract infection, occurring in 15.4% (95% CI 5.9-30.5%) of cases compared with 4.0% (95% CI 2.5-6.2%) of those without urinary retention (P=.008).


CONCLUSIONS
Transient urinary retention is relatively more common after robotic hysterectomy when compared with laparoscopic hysterectomy. We postulate that more aggressive bladder dissection performed with robot assistance may be associated with an increased risk of urinary retention.
Department of Obstetrics and Gynecology, University of Michigan Health Center, Ann Arbor, Michigan 48109, USA. noam_yossi@yahoo.com
Noam
N
Smorgick
John
J
DeLancey
Kristin
K
Patzkowsky
Arnold
A
Advincula
Arleen
A
Song
Sawsan
S
As-Sanie
D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D015994:Incidence; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017699:Pelvic Pain / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology*; D014592:Uterine Hemorrhage / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery