A Risk Calculator for Post-Operative Urinary Retention (POUR) Following
Vaginal Pelvic Floor Surgery: Multivariable Prediction Modelling
Abstract
Objective: To determine the peri-operative characteristics associated
with an increased risk of post-operative urinary retention (POUR)
following vaginal pelvic floor surgery. Design: A retrospective cohort
study using multivariable prediction modelling. Setting: A tertiary
referral urogynaecology unit. Population: Patients undergoing vaginal
pelvic floor surgery from January 2015 to February 2020. Methods:
Eighteen variables (24 parameters) were compared between those with and
without POUR and then included as potential predictors in statistical
models to predict POUR. The final model was chosen as the one with the
largest c-index from internal cross-validation. This was then externally
validated using a separate data set (n=94) from another surgical centre.
Main Outcome Measures: diagnosis of POUR following surgery while the
patient was in hospital. Results: Among the 700 women undergoing
surgery, 301 (43%) experienced POUR. Pre-operative variables with
statistically significant univariate relationships with POUR included
age, menopausal status, prolapse stage, and uroflow parameters.
Significant peri-operative factors included estimated blood loss, amount
of intravenous fluid administered, operative time, length of stay, and
specific procedures including vaginal hysterectomy with intraperitoneal
vault suspension, anterior colporrhaphy, posterior colporrhaphy, and
colpocleisis. The lasso logistic regression model had the best
combination of internally cross-validated c-index (0.73) and accurate
calibration curve. Using this data, a POUR risk calculator was developed
(https://pourrisk.shinyapps.io/POUR/). Conclusions: This POUR risk
calculator will allow physicians to counsel patients pre-operatively on
their risk of developing POUR after vaginal pelvic surgery and help
focus discussion around potential management options.