Int Urogynecol J

DOI 10.1007/s00192-014-2418-6

REVIEW ARTICLE

Postpartum urinary retention: a systematic review of adverse

effects and management
F. E. M. Mulder & R. A. Hakvoort & M. A. Schoffelmeer &
J. Limpens & J. A. M. Van der Post & J. P. W. R. Roovers

Received: 21 January 2014 / Accepted: 22 April 2014

# The International Urogynecological Association 2014

Abstract clinicians should be aware of the potential consequences and

Introduction and hypothesis Postpartum urinary retention
(PUR) is a well-known condition after childbirth. Often clini-
cians assume that this condition is transient, either through
belief or by not being aware that its occurrence as measure-
ment of post-void residual volume (PVRV) is often not rou-
tine. However, long lasting urinary retention is a serious
condition that needs management in order to prevent urogen-
ital tract morbidity. By performing a systematic review of the
adverse effects of PUR and management of this condition, we
aimed to identify the necessity of diagnosing this condition in
the puerperium and to evaluate whether treatment is required.
Methods We searched for all studies on PUR in OVID
MEDLINE, OVID EMBASE, and ongoing Trial registers.
Two reviewers independently screened and extracted the data.
Results Twenty-four papers were included in this review.
Limited data on adverse effects demonstrate potential morbid-
ities, like micturition symptoms and sporadically spontaneous
bladder ruptures, related to PUR.
Conclusions Based on current literature, evidence stating that
PUR is harmless is lacking. Future research should focus on
management strategies for overt PUR and the long-term con-
sequences of covert PUR. Until these results are available,
F. E. M. Mulder (*) : M. A. Schoffelmeer : J. A. M. Van der Post :
J. P. W. R. Roovers
Department of Obstetrics and Gynaecology, Academic Medical
Centre, Meibergdreef 9, H4room 210, 1105 AZ Amsterdam,
The Netherlands
e-mail: f.e.mulder@amc.uva.nl
R. A. Hakvoort
Department of Obstetrics and Gynaecology, Spaarne Hospital,
Hoofddorp, The Netherlands
J. Limpens
Medical Library, Academic Medical Centre, Amsterdam,
The Netherlands
therefore keep trying to identify patients at risk of PUR and
patients with the actual condition.
Keywords Postpartum . Urinary retention . Voiding
dysfunctions . Bladder dysfunction . Post-void residual
volume (PVRV) . Adverse effects
Abbreviations
PUR Postpartum urinary retention
PVRV Post-void residual volume
CIC Clean intermittent catheterization
Introduction
Postpartum urinary retention (PUR) is a common phenome-
non in the puerperium, with prevalences varying between
1.5 % and 45 % [14]. In the literature a distinction is often
made between patients who cannot void at all (overt postpar-
tum urinary retention) and those who can void, but experience
an abnormal post-void residual bladder volume (covert PUR).
This distinction was first made by Yip et al., who defined overt
PUR as: the inability to void spontaneously within six hours
after vaginal delivery or six hours after removal of an indwell-
ing bladder catheter after caesarean section, requiring cathe-
terization [1]. Covert PUR was classified as a post void
residual bladder volume (PVRV) of150 ml after spontane-
ous micturition, verified by ultrasound or catheterization.
Since then, these definitions have been adopted by several
authors [48].
Long-term and adverse effects of postpartum urinary reten-
tion have not yet been identified; therefore, screening for
increased PVRV is often not part of standard postpartum care.
This is in contrast to patients after (gynaecological) surgery,

where screening for urinary retention has often become part of
routine postoperative care [913].
In patients with persistent urinary retention (for example,
due to pelvic masses, benign prostate hyperplasia or postop-
eratively), long-term micturition problems, due to detrusor
failure, and even kidney failure due to renal obstruction,
anuria and hydronephrosis have been described [1417]. In
addition, persistent micturition problems have been described
after a single episode of detrusor overdistention [18, 19].
Although the pathophysiology remains unelucidated, vari-
ous factors have found to be of influence from which several
hypotheses on the cause of postpartum urinary retention have
arisen. Regarding bladder physiology, Muellner showed that
the capacity of the bladder increases during pregnancy [20].
Iosif et al. performed urodynamic tests in pregnant and post-
partum women, showing adaptations of urethral length and
urethral closure pressures during pregnancy [21]. This phys-
iological increase in the length of the urethra as well as the
increase in the maximum urethral pressure and urethral clo-
sure pressure is responsible for protection against urinary
incontinence in pregnancy [21]. Vaginal delivery can directly
traumatize pelvic floor muscles and innervations, which is
likely to result in decreased bladder sensibility [22]. More-
over, it causes peri-urethral and vulvar oedema, which may
also result in PUR by obstruction. Although no comparisons
have been made, it is feasible that the mode of delivery
(vaginal delivery versus caesarean section) also affects the
bladder function.
Finally, hormonal changes may influence the function of
the bladder during pregnancy and in the puerperium. Recently,
Liang and colleagues explored hormone levels in rats with and
those without PUR; they found that rats with PUR had in-
creased progesterone levels, resulting in shorter intervals be-
tween contraction of the bladder muscle cells, lower mean
voided volumes and increased residual volumes [23].
While in the puerperium morbidity related to postpar-
tum urinary retention is not well documented and pos-
sibly under-reported, the potential damage of enduring
retention and the uncertainty about actual incidence
does not exempt clinicians from being vigilant about
the occurrence of retention.
In addition, the lack of screening for PUR or (abnormal)
PVRV in the postpartum period also causes practice variations
in daily clinical practice and management after delivery,
which may cause under- or over-treatment of patients [24].
The aim of this review is to provide an answer to whether
PUR needs to be diagnosed and whether an intervention is
needed. This would be true in the case of a clear relationship
existing between the existence of PUR and the morbidity of
the urogenital tract. To establish a possible relationship, a
review was performed of the available literature on the inci-
dence of adverse effects of overt and covert PUR and the need
for interventions in women who suffer from it.
Int Urogynecol J
Materials and methods
A medical librarian (JL) performed a systematic literature
search in MEDLINE (OVID, from 1948), EMBASE (OVID,
from 1980), PubMed (which contains publications ahead of
print, not yet included in OVID MEDLINE) and ongoing Trial
registers (http://clinicaltrials.gov/) to identify publications
about PUR. The latest update was 11 November 2013. No
language restrictions were applied and animal studies were
safely excluded by double negation. The search strategy
consisted of free-text words and subject headings related to
urinary retention, and delivery, postpartum period or obstetric
procedures that enhance the chance of urinary retention (see
Appendix for the entire MEDLINE search strategy) [25]. The
search included an iterative process, for each database, to
refine the search strategy through incorporation of new search
terms as new relevant citations were identified, i.e. by
checking reference lists and citing articles using ISI Web of
Science. The bibliographic records retrieved were
downloaded and imported into Reference Manager software
(version 12.0) to deduplicate, store and analyse the search
results.
Papers included involved original data on women diag-
nosed with postpartum urinary retention (after vaginal deliv-
ery or caesarean section) as well as women with an abnor-
mal PVRV (as defined by the author). Also, papers with
urinary retention as a secondary outcome were used for anal-
ysis. If data were inconclusive or insufficient, authors were
contacted.
After identifying all available papers on PUR, manuscripts
reporting on adverse events and treatment were selected and
used in the final analysis.
Two authors (FM and MS) independently assessed for
inclusion all the potential studies that were identified as a
result of the search strategy. The STROBE guideline was used
in order to evaluate the quality of the studies included [26].
Any disagreements between the two reviewers were resolved
through discussion.
Results
The systematic search identified 909 unique papers on PUR,
of which 24 were eligible for data extraction (Fig. 1).
On overt PUR, 10 prospective studies [1, 47, 2731] were
found as well as 6 retrospective studies [8, 3236]. Three
studies reported on protracted or prolonged PUR [3739].
On covert PUR, 14 prospective studies were identified [14,
7, 30, 4047].
We identified all papers that reported on any complication
potentially related to PUR, like micturition problems, urinary
tract infections or incontinence.
Int Urogynecol J
Fig. 1 Literature identification
and study selection included MEDLINE
Identification
(n = 343)
Records aer duplicates removed
Screening
Eligibility
Included
Considering overt PUR, three studies reported on adverse
effects [2, 4, 48]. Two authors evaluated long-term conse-
quences, both 4 years after delivery. Andolf et al. reviewed 10
PUR patients with a questionnaire. Three out of 10 patients
experienced occasional voiding problems, but the study was too
small to claim that urinary symptoms in patients diagnosed with
PUR are not increased compared with the general population
[2]. Yip and colleagues reviewed patients with and without PUR
4 years after the (vaginal) index delivery. Of the 394 patients
contacted by telephone, 73 had previously been diagnosed with
PUR. No distinction was made between women with overt and
those with covert PUR. No statistical significance for urinary
stress incontinence was found between patients with and those
without PUR (71 % vs 61 %) [48]. Another group evaluated
women 3 months after having gone through an episode of PUR
by uroflowmetry and a questionnaire on subjective symptoms
[4]. One of the two overt PUR patients had voiding dysfunctions
(not otherwise specified), the other patient did not show
urodynamic disturbances nor was she symptomatic.
Another defined entity regarding overt PUR came forward
from the literature: urinary retention lasting for longer than
3 days and requiring catheterisation for a longer period. This is
called prolonged, persistent or chronic postpartum urinary
EMBASE PubMed Publisher[sb]
(n = 835) (n = 6)
(n = 909)
Records screened by Records excluded (n = 185)
tle and/or abstract
(n = 273)
Full-text arcles assessed Full-text arcles excluded
for eligibility (n=71)
(n = 95) - No original data (n = 71)
Studies included in
data synthesis
(n = 24)
retention and was described by 5 authors [32, 38, 37, 39,
4951]. Concerning adverse effects, Groutz et al. performed
urodynamic investigation in 48 out of 55 women with
prolonged PUR, 339 months after delivery; 10 % were
diagnosed with stress incontinence and 8 % with overactive
bladder signs [37]. Humburg and colleagues presented 2 cases
of patients with prolonged PUR, resulting in suprapubic cath-
eterisation and antibiotic treatment for urinary tract infections
[39]. No comparison with women without prolonged PUR
was made.
Most authors supported the opinion that covert PUR is
ephemeral and no treatment is necessary. Possibly, as a con-
sequence, no papers were found on the management of covert
PUR. Therefore, in contrast to overt PUR, where the indica-
tion for treatment is clearer, groups have been able to scruti-
nise covert PUR in its natural course. Five authors studied the
PVRV repeatedly after initial diagnosis of covert PUR, show-
ing that in 96100 % of cases, PVRV normalised within 2 to
5 days of delivery [1, 3, 4, 36, 46]. In 9 papers the PVRV was
only measured once in order to diagnose PUR (Table 1) [2, 7,
30, 4045].
Regarding the negative effects of covert PUR, 3 of the 13
included studies mentioned adverse effects [2, 45, 46]. Andolf
 Int Urogynecol J

Table 1 Natural course of covert

postpartum urinary retention Reference Time Prevalence PUR (%) Natural course covert PUR
(PUR)
Ramsay and Torbet [45] Mean 72 h 0.4 NA
Andolf et al. [2] 72 h 1.5 NA
Lee et al. [46] 24 h 14 Day 5: 98 % PVRV<200 ml
Yip et al. [1, 59] 24 h 9.7 Day 4: 100 % PVRV<150 ml
Kekre et al. [4] After 1st void 10 Day 2: 98 % PVRV<150 ml 2
patients overt PUR: CAD 48 h
Hee et al. [3] After 1st void 45 Day 3: 92 % PVRV<100 ml;
day 5: 96 % PVRV<100 ml
Chai et al. [40] 6h 3.4 Measurements not repeated
Weissman et al. [44] 42 h 7.5 Measurements not repeated
Demaria et al. [43] 72 h 36 Measurements not repeated
Ismail and Emery [44] 48 h 37 Measurements not repeated
Liang et al. [7] 6h 16.7 All patients catheterised; no
information on natural
course
Van Os and Van den Linden [42] 6h 32 All patients catheterised; no
information on natural
course
Lee [30] <18 h 8 All patients catheterised; no
information on natural
course
Buchanan and Beckmann [36] 4h 5.1 Day 4: 97 % PVRV<150 ml
NA no data available

et al. included patients with a PVRV>150 ml on the 3rd day
postpartum and re-evaluated them at day 4 and day 5 postpar-
tum, as well as 4 years after delivery. None of the patients had
an increased PVRV at day 5 postpartum, indicating that PUR
is a transient condition. At the 4-year follow-up, 3 patients
(30 %) reported occasional voiding problems (urgency and
stress incontinence); however, in this study no differentiation
between overt and covert PUR was made and a control group
of women without PUR was lacking [2].
Lee et al. evaluated 256 patients on the 2nd day after
vaginal delivery. Thirty-six patients had PVRV exceeding
200 ml. Forty-two percent of these patients had symptoms
of voiding dysfunction at that time (urinary frequency, dys-
uria, incontinence, sensation of incomplete emptying or diffi-
culty voiding as defined by the authors). On the 5th day, 1.8 %
of all patients (4 out of 228) still had a PVRV>200 ml. Of
these 4 patients none had symptoms of voiding dysfunction.
In total, 92 % of the patients with covert PUR recovered
spontaneously [46]. Eleven authors did not report any adverse
effects.
With regard to adverse effects, several cases have been
published on spontaneous bladder ruptures after vaginal
delivery [5257]. Although no information is available
on the micturition of these women after giving birth, it
is possible that this severe and detrimental urological
complication is related to PUR. However, no cases of
spontaneous bladder rupture have been recorded in cohort
studies on PUR.
Although the necessity of management for overt PUR is
indisputable (i.e. catheterisation), clinical guidelines are lack-
ing. Concerning studies reporting on overt PUR, the treatment
protocol was mentioned in 13 papers [1, 48, 2733]. Six
authors reported that treatment of overt PUR started with
indwelling catheterisation, with time varying from 24 up to
72 h [1, 4, 8, 27, 28]. One author only used intermittent
catheterisation [5], while in 4 studies, after initial treatment
with intermittent catheterisation, indwelling catheterisation
after 24 h was started [6, 7, 29, 30]. In 2 studies both inter-
ventions were applied [32, 33]. Spontaneous micturition oc-
curred in all of the patients included, with catheterisation time
varying from 24 h up to 45 days [5, 34]. An overview of the
differences in management strategies is presented in Table 2.
Discussion
This systematic review shows that PUR is a frequent condition
in the puerperium and that there is no evidence indicating that
it is harmless.
Literature on the adverse effects of PUR shows that covert
PUR is often a transient condition. However, owing to the
absence of control groups (patients with normal PVRV), there
is little to say about the relationship between the attributed risk
of covert PUR and the later development of micturition symp-
toms. Although spontaneous bladder rupture is rarely
Int Urogynecol J

Table 2 Treatment and recovery for overt PUR

Reference Prevalence of PUR (%) Initial treatment Time of treatment Longest treatment

Carley et al. [34] 0.45 CIC and CAD (not specified) 45 %<48 h; 29 %<72 h; 25 % 45 days
self-catheterisation
Ching-Chung et al. [6] 3.97 CIC followed by CAD 98 %<72 h 10 days
Fedorkow et al. [33] 0.34 CIC and CAD (not specified) NA NA
Foon et al. [28] 2.50 CAD NA NA
Glavind and Bjork [5] 0.70 CIC 47 %<24; 33 %<48 h; 20 % 21 days
self-catheterisation
Kekre et al. [4] 0.30 CAD 100 %<48 h N/A
Liang et al. [7] 7.40 CIC followed by CAD 65 % 1x CIC; 23 % 2x CIC; 48 h
11 % CAD
Liang et al. [29] 12.0 CIC followed by CAD 83 %<24 h; 11 %<48 h; At hospital discharge
5 %<72 h
Musselwhite et al. [35] 4.70 NA NA NA
Olofsson et al. [27] 0.89 CAD 27 %<72 h; 53 %<14 days > 14 days
Rizvi et al. [8] 0.14 CAD Median time: 72 h 148 h
Teo et al. [32] 0.20 CIC and CAD (not specified) Median time: 19 days 85 days
Yip et al. [1] 4.90 CAD NA NA
Lee [30] 8.0 CIC followed by CAD NA NA
Sherline and Danforth [31] 3.0 CAD Median time: 52 h 96 h

NA no data available

described in case reports, this complication is absent in cohort
studies.
Regarding negative and harmful effects related to covert
PUR, we believe there is too little current evidence to declare
that PUR is a physiological condition, while, in general,
follow-up periods have been short and no comparisons with
well-voiding subjects have been made.
For overt PUR, 3 authors evaluated adverse effects [1, 2,
4]. The follow-up period in the study of Kekre et al. was
limited to 3 months and only 2 patients, 1 of whom was lost
to follow-up [4]. Although Yip et al. and Andolf et al.
reviewed patients 4 years after the diagnosis of PUR, owing
to low numbers of patients and different definitions, we be-
lieve that these results are too limited to state that PUR does
not result in any long-term problems [2, 48]. The revised
group of patients with PUR in Andolf et al.s study was very
small (n=12) and different inclusion criteria were used. In
addition, no difference was found in patients with overt and
covert PUR [2]. Yip et al. were able to reassess a large number
of patients using telephone interviews 4 years after the diag-
nosis of PUR [48]. Although they did make a comparison
between patients with and those without PUR, again, no
distinction was made between overt and covert PUR. In
addition, no validated questionnaires were used and women
were allowed to answer only parts of the questionnaire used.
Considering covert PUR, 3 authors reported on negative
effects [2, 45, 46]. Lee et al. identified that 42 % of women
with covert PUR had voiding problems (not otherwise spec-
ified) on the 2nd day after delivery. On the 5th day, 4 patients
still had an increased PVRV, but were asymptomatic. No
further information was given regarding the characteristics of
these patients. Andolf and colleagues identified patients with a
PVRV>150 ml on the 3rd day postpartum. All patients had
normal voiding parameters within several days. They found
no differences regarding urinary symptoms comparing pa-
tients with PUR with the general population.
The majority of authors studying covert PUR had no
follow-up regarding adverse effects; clinical studies with
long-term follow up and associations with control groups of
patients with normal voiding parameters were lacking. In the
absence of sufficiently powered and properly designed studies
we therefore believe that a true statement about the benign
character of covert PUR is not possible. Future research on
covert PUR should not only include comparisons with normal
controls, but should also focus on long-term adverse effects.
In addition, validated questionnaires should be used. Until the
results of such studies are available, patients who are at risk of
covert PUR should be monitored closely [58].
Bladder overdistention can reduce the contractility of
the detrusor muscle and create micturition symptoms.
Therefore, in women with overt postpartum urinary reten-
tion, timely recognition and treatment by catheterisation is
essential in preventing this disorder [18, 19]. However, our
review shows that standardised diagnostics and manage-
ment for overt PUR are lacking. Further, a large variation
exists in catheterisation protocols (intermittent versus in-
dwelling catheterisation as well as duration of catheterisa-
tion) [1, 5, 6, 27, 34].

While catheterisation after (vaginal) surgery and acute
urinary retention is well evaluated in clinical studies, evidence
for indwelling or intermittent catheterisation in postpartum
patients is lacking. Different studies conclude that intermittent
catheterisation is preferred over indwelling catheterisation as a
primary treatment [8, 59]. This is in line with a recent
Cochrane review on postoperative acute urinary retention in
adults that shows restricted evidence in favour of clean inter-
mittent catheterisation (CIC); it is associated with a lower risk
of bacteriuria than indwelling catheterisation [60, 61]. The
same conclusion was drawn by two authors studying women
during labour [62, 63]. However, no comparison between
different catheterisation methods has been made for overt
PUR. We therefore believe that a study comparing the two
techniques is needed.
Regarding treatment for covert PUR, consensus is lacking.
Studies conducted on this subject are restricted to repeated
measurements of the PVRV and the so-called natural course.
While most patients were able to void sufficiently, authors
conclude that covert PUR is transient and therefore self-
limiting [14, 28, 29, 42, 44]. However, a normal PVRV after
initially increased residual volume does not guarantee the
absence of symptoms and complications. While information
on complications due to covert PUR is insufficient, we believe
that the statement that covert PUR does not need treatment can
only be justified when expectant management is compared
with an intervention. In the meantime, there is insufficient
evidence advising routine screening of all postpartum women
after spontaneous micturition.
Our study has some weaknesses that have to be
acknowledged. First, owing to the variety in cut-off
values and definitions used in the studies included, it
is not possible to generate incidences of adverse effects.
The variations in the time of measurement of the PVRV
(from 6 up to 72 h postpartum) and multiple diagnostic
instruments (ultrasound, catheterisation) make it difficult
to compare results and therefore produce absolute num-
bers on the potential negative effects of PUR. This
limitation is consequently the result of the studies in-
cluded. We therefore recommend use of the definitions
generated by Yip et al. [1]. If the terminology can be
agreed upon, reported prevalences can be compared
more easily and future study results can be used for
meta-analysis.
Second, as treatment options contrast widely between stud-
ies, sufficient evidence to constitute a treatment guideline for
PUR is lacking. Future research should therefore focus on the
adverse effects of PUR, catheterisation methods in women
with overt PUR and the necessity for screening and treating
covert PUR. Although we have not been able to generate
recommendations for daily clinical practice, we believe that
our review shows that overt and covert PUR cannot be
disregarded.
Int Urogynecol J
Conclusion
Postpartum urinary retention is a frequently diagnosed condi-
tion in the postpartum period. While only a few studies
scrutinised the adverse effects of overt and covert PUR, evi-
dence that PUR is without danger of long-term adverse effects
is insufficient. Although not statistically significant, data show
increased urinary problems in patients with PUR. Case reports
on spontaneous bladder ruptures after vaginal delivery imply
that urinary retention might be detrimental.
Consequently, future research should focus more on short-
and long-term consequences of PUR, catheterisation methods
for overt PUR and the necessity for treatment for covert PUR.
Although until these results are available PUR should be
regarded as a serious condition, we do not recommend routine
screening for increased PVRV.
Conflicts of interest None.
References
1. Yip SK, Brieger G, Hin LY, Chung T (1997) Urinary retention in the
post-partum period. The relationship between obstetric factors and
the post-partum post-void residual bladder volume. Acta Obstet
Gynecol Scand 76:667672
2. Andolf E, Iosif CS, Jorgensen C, Rydhstrom H (1994) Insidious
urinary retention after vaginal delivery: prevalence and symptoms
at follow-up in a population-based study. Gynecol Obstet Investig 38:
5153
3. Hee P, Lose G, Beier-Holgersen R, Engdahl E, Falkenlove P (1992)
Postpartum voiding in the primiparous after vaginal delivery. Int
Urogynecol J 3:9599
4. Kekre AN, Vijayanand S, Dasgupta R, Kekre N (2011) Postpartum
urinary retention after vaginal delivery. Int J Gynaecol Obstet 112:
112115
5. Glavind K, Bjork J (2003) Incidence and treatment of urinary reten-
tion postpartum. Int Urogynecol J Pelvic Floor Dysfunct 14:119121
6. Ching-Chung L, Shuenn-Dhy C, Ling-Hong T, Ching-Chang H,
Chao-Lun C, Po-Jen C (2002) Postpartum urinary retention: assess-
ment of contributing factors and long-term clinical impact. Aust N Z
J Obstet Gynaecol 42:365368
7. Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ
(2007) Postpartum urinary retention after cesarean delivery. Int J
Gynaecol Obstet 99:229232
8. Rizvi RM, Khan ZS, Khan Z (2005) Diagnosis and management of
postpartum urinary retention. Int J Gynaecol Obstet 91:7172
9. Hakvoort RA, Dijkgraaf MG, Burger MP, Emanuel MH, Roovers JP
(2009) Predicting short-term urinary retention after vaginal prolapse
surgery. Neurourol Urodyn 28:225228
10. Fitzgerald MP, Kulkarni N, Fenner D (2000) Postoperative resolution
of urinary retention in patients with advanced pelvic organ prolapse.
Am J Obstet Gynecol 183:13611363
11. Sokol AI, Jelovsek JE, Walters MD, Paraiso MF, Barber MD (2005)
Incidence and predictors of prolonged urinary retention after TVT
with and without concurrent prolapse surgery. Am J Obstet Gynecol
192:15371543
12. Smorgick N, DeLancey J, Patzkowsky K, Advincula A, Song A, As-
Sanie S (2012) Risk factors for postoperative urinary retention after
Int Urogynecol J
laparoscopic and robotic hysterectomy for benign indications. Obstet
Gynecol 120:581586
13. Stallard S, Prescott S (1988) Postoperative urinary retention in gen-
eral surgical patients. Br J Surg 75:11411143
14. Mustonen S, Ala-Houhala IO, Tammela TL (2001) Long-term renal
dysfunction in patients with acute urinary retention. Scand J Urol
Nephrol 35:4448
15. Mustonen S, Ala-Houhala IO, Turjanmaa V, Tammela TL (2001)
Effect of acute urinary retention on glomerular filtration rate. Clin
Nephrol 56:8182
16. Abe T, Shinno Y, Kawakura K, Moriya K (2000) Acute renal failure
occurring from urinary retention due to a mullerian duct cyst. Int J
Urol 7:6971
17. Lewis JM, Yalla SV, Stanitski KE, Sullivan MP (2012) Spectrum of
urodynamic abnormalities and renal function changes in adult men
with non-neurogenic urinary retention. Neurourol Urodyn 31:544548
18. Bross S, Schumacher S, Scheepe JR, Zendler S, Braun PM, Alken P,
Junemann K (1999) Effects of acute urinary bladder overdistension on
bladder response during sacral neurostimulation. Eur Urol 36:354359
19. Madersbacher H, Cardozo L, Chapple C, Abrams P, Toozs-Hobson P,
Young JS, Wyndaele JJ, De WS, Campeau L, Gajewski JB (2012)
What are the causes and consequences of bladder overdistension?
ICI-RS 2011. Neurourol Urodyn 31:317321
20. Muellner S (1938) Physiological bladder changes during pregnancy
and the puerperium. J Urol 41:691
21. Iosif S, Ingemarsson I, Ulmsten U (1980) Urodynamic studies in
normal pregnancy and in puerperium. Am J Obstet Gynecol 137:
696700
22. Snooks SJ, Swash M, Mathers SE, Henry MM (1990) Effect of
vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg
77:13581360
23. Liang CC, Lin YH, Chen TC, Chang SD (2014) How antepartum and
postpartum acute urinary retention affects the function and structure
of the rat bladder. Int Urogynecol J doi:10.1007/s00192-013-2320-7
24. Zaki MM, Pandit M, Jackson S (2004) National survey for
intrapartum and postpartum bladder care: assessing the need for
guidelines. BJOG 111:874876
25. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC,
Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009)
The PRISMA statement for reporting systematic reviews and meta-
analyses of studies that evaluate health care interventions: explana-
tion and elaboration. J Clin Epidemiol 62:e1e34
26. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC,
Vandenbroucke JP (2008) The Strengthening the Reporting of
Observational Studies in Epidemiology (STROBE) statement: guide-
lines for reporting observational studies. J Clin Epidemiol 61:344349
27. Olofsson CI, Ekblom AO, Ekman-Ordeberg GE, Irestedt LE (1997)
Post-partum urinary retention: a comparison between two methods of
epidural analgesia. Eur J Obstet Gynecol Reprod Biol 71:3134
28. Foon R, Toozs-Hobson P, Millns P, Kilby M (2010) The impact of
anesthesia and mode of delivery on the urinary bladder in the post-
delivery period. Int J Gynaecol Obstet 110:114117
29. Liang CC, Chang SD, Wong SY, Chang YL, Cheng PJ (2010) Effects
of postoperative analgesia on postpartum urinary retention in women
undergoing cesarean delivery. J Obstet Gynaecol Res 36:991995
30. Lee J (1961) Management of postpartum urinary retention. Obstet
Gynecol 17:464471
31. Sherline DM, DANFORTH DN (1962) Effects of labor, delivery, and
anesthesia on postpartum bladder function. Obstet Gynecol 19:808813
32. Teo R, Punter J, Abrams K, Mayne C, Tincello D (2007) Clinically
overt postpartum urinary retention after vaginal delivery: a retrospec-
tive casecontrol study. Int Urogynecol J Pelvic Floor Dysfunct 18:
521524
33. Fedorkow DM, Drutz HP, Mainprize TC (1990) Characteristics of
patients with postpartum urinary retention. Int Urogynecol J 1:136
138
34. Carley ME, Carley JM, Vasdev G, Lesnick TG, Webb MJ, Ramin
KD, Lee RA (2002) Factors that are associated with clinically overt
postpartum urinary retention after vaginal delivery. Am J Obstet
Gynecol 187:430433
35. Musselwhite KL, Faris P, Moore K, Berci D, King KM (2007) Use of
epidural anesthesia and the risk of acute postpartum urinary retention.
Am J Obstet Gynecol 196:472475
36. Buchanan J, Beckmann M (2014) Postpartum voiding dysfunction:
identifying the risk factors. Aust N Z J Obstet Gynaecol 54:4145
37. Groutz A, Gordon D, Wolman I, Jaffa A, Kupferminc MJ, Lessing JB
(2001) Persistent postpartum urinary retention in contemporary ob-
stetric practice. Definition, prevalence and clinical implications. J
Reprod Med 46:4448
38. Groutz A, Levin I, Gold R, Pauzner D, Lessing JB, Gordon D (2011)
Protracted postpartum urinary retention: the importance of early
diagnosis and timely intervention. Neurourol Urodyn 30:8386
39. Humburg J, Holzgreve W, Hoesli I (2007) Prolonged postpartum
urinary retention: the importance of asking the right questions at the
right time. Gynecol Obstet Investig 64:6971
40. Chai AH, Wong T, Mak HL, Cheon C, Yip SK, Wong AS (2008)
Prevalence and associated risk factors of retention of urine after cae-
sarean section. Int Urogynecol J Pelvic Floor Dysfunct 19:537542
41. Weissman A, Grisaru D, Shenhav M, Peyser RM, Jaffa AJ (1995)
Postpartum surveillance of urinary retention by ultrasonography: the
effect of epidural analgesia. Ultrasound Obstet Gynecol 6:130134
42. Van Os AF, Van der Linden PJ (2006) Reliability of an automatic
ultrasound system in the post partum period in measuring urinary
retention. Acta Obstet Gynecol Scand 85:604607
43. Demaria F, Amar N, Biau D, Fritel X, Porcher R, Amarenco G,
Madelenat P, Benifla JL (2004) Prospective 3D ultrasonographic
evaluation of immediate postpartum urine retention volume in 100
women who delivered vaginally. Int Urogynecol J Pelvic Floor
Dysfunct 15:281285
44. Ismail SI, Emery SJ (2008) The prevalence of silent postpartum
retention of urine in a heterogeneous cohort. J Obstet Gynaecol 28:
504507
45. Ramsay IN, Torbet TE (1993) Incidence of abnormal voiding parameters
in the immediate postpartum period. Neurourol Urodyn 12:179183
46. Lee SN, Lee CP, Tang OS, Wong WM (1999) Postpartum urinary
retention. Int J Gynaecol Obstet 66:287288
47. Liang CC, Wong SY, Tsay PT, Chang SD, Tseng LH, Wang MF,
Soong YK (2002) The effect of epidural analgesia on postpartum
urinary retention in women who deliver vaginally. Int J Obstet Anesth
11:164169
48. Yip SK, Sahota D, Chang AM, Chung TK (2002) Four-year follow-
up of women who were diagnosed to have postpartum urinary
retention. Am J Obstet Gynecol 187:648652
49. Jeffery TJ, Thyer B, Tsokos N, Taylor JD (1990) Chronic urinary
retention postpartum. Aust N Z J Obstet Gynaecol 30:364366
50. Humburg J, Troeger C, Holzgreve W, Hoesli I (2011) Risk factors in
prolonged postpartum urinary retention: an analysis of six cases.
Arch Gynecol Obstet 283:179183
51. Watson WJ (1991) Prolonged postpartum urinary retention. Mil Med
156:502503
52. Duenas-Garcia OF, Rico H, Gorbea-Sanchez V, Herrerias-Canedo T
(2008) Bladder rupture caused by postpartum urinary retention.
Obstet Gynecol 112:481482
53. Gaikwad PR, Sharma S, Kanitkar SV, Kachane T (2011)
Spontaneous rupture of the urinary bladder in the puerperium. J
Obstet Gynecol India 61:208209
54. Png KS, Chong YL, Ng CK (2008) Two cases of intraperitoneal
bladder rupture following vaginal delivery. Singapore Med J 49:327
329
55. Roberts C, Oligbo N, Swinhoe J (1996) Spontaneous bladder rupture
following normal vaginal delivery: a postpartum emergency. Br J
Obstet Gynaecol 103:381382

56. Kekre AN, Kekre N, Nath V, Seshadri L (1997) Spontaneous rupture
of the urinary bladder in the puerperium. Aust N Z J Obstet Gynaecol
37:473474
57. Wandabwa J, Otim T, Kiondo P (2004) Spontaneous rupture of
bladder in puerperium. Afr Health Sci 4:138139
58. Mulder F, Schoffelmeer M, Hakvoort R, Limpens J, Mol B, van der
Post J, Roovers J (2012) Risk factors for postpartum urinary reten-
tion: a systematic review and meta-analysis. BJOG 119:14401446
59. Yip SK, Sahota D, Pang MW, Day L (2005) Postpartum urinary
retention. Obstet Gynecol 106:602606
60. Niel-Weise BS, van den Broek PJ (2005) Urinary catheter policies for
short-term bladder drainage in adults. Cochrane Database Syst Rev 7:
CD004203
Int Urogynecol J
61. Hakvoort R, Thijs S, Bouwmeester F, Broekman A, Ruhe I, Vernooij
M, Burger M, Emanuel M, Roovers J (2011) Comparing clean
intermittent catheterisation and transurethral indwelling catheterisa-
tion for incomplete voiding after vaginal prolapse surgery: a
multicentre randomised trial. BJOG 118:10551060
62. Evron S, Dimitrochenko V, Khazin V, Sherman A, Sadan O, Boaz M,
Ezri T (2008) The effect of intermittent versus continuous bladder
catheterization on labor duration and postpartum urinary retention
and infection: a randomized trial. J Clin Anesth 20:567572
63. Millet L, Shaha S, Bartholomew ML (2012) Rates of bacteri-
uria in laboring women with epidural analgesia: continuous vs
intermittent bladder catheterization. Am J Obstet Gynecol 206:
316317