To evaluate and summarise the best evidence on the prevention and management of postoperative urinary retention (POUR) following pelvic floor reconstruction and provide an evidence-based foundation for clinical practice.
Adhering to the top-down principle of the 6S model of evidence-based resources, all evidence from domestic and international databases and websites on the prevention and management of POUR after pelvic floor reconstruction, including clinical decisions, evidence-based guidelines, evidence summaries, systematic reviews, meta-analyses and expert consensus statements, was systematically searched from the inception of each database to May 9, 2024. Quality assessment, evidence extraction and summarisation were performed by two researchers. This study was registered with the Evidence-Based Nursing Center of Fudan University (registration number: ES20244725).
Twenty-one studies were included and used to develop 26 evidence-based recommendations, which were categorised into five areas: risk assessment and information, preventive measures, early identification, management strategies and follow-up management. Preoperative evaluation should include the patient's urination status, postvoid residual (PVR) and risk factors for POUR, without the routine need for urodynamic testing. During surgery, excessive separation of the urethra should be minimised, and the sling or mesh should be kept tension-free. Catheters should be removed 24-48 h post-operatively, followed by a timely voiding trial, with retrograde voiding trials recommended. Intermittent catheterisation or indwelling catheterisation is considered the primary treatment option for POUR. If necessary, sling or mesh loosening may be performed, while sling or mesh release should be approached with caution, and urethral dilation is not recommended. A follow-up assessment of urination status is advised at least once within 6 weeks postsurgery.
These 26 pieces of evidence provide guidance for healthcare professionals in standardising the management of POUR following pelvic floor reconstructive surgery. However, because this evidence comes from different countries, healthcare professionals are encouraged to apply it in specific clinical contexts to optimise patient outcomes. Future research should focus more on risk assessment tools and specific preventive measures for POUR following pelvic floor surgery.
Journal of nursing management. 2026 Jan [Epub]
Linlin Zhou, Chunyan She, Shuang Hu, Xue Su, Lubin Liu, Ling Dai
Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China.