Clinical Significance of Bladder Sensory Loss and Bladder Overdistension in Persistent Postpartum Urinary Retention.

OBJECTIVE: To explore clinical and bladder-related factors associated with postpartum urinary retention (PUR), with particular emphasis on bladder sensation and bladder overdistension. METHODS: This retrospective pilot cohort study included 30 women diagnosed with PUR following vaginal or cesarean delivery. PUR was defined as inability to void within 6 hours postpartum or elevated postvoid residual volume. Persistent PUR was defined as retention requiring catheterization beyond 7 days. Patients were classified into persistent and non-persistent groups. Clinical, obstetric, and bladder-related variables were compared. Multivariable logistic regression was performed in an exploratory manner to identify factors independently associated with persistent PUR. RESULTS: Persistent PUR was observed in 18 patients (60%). Patients with persistent PUR more frequently had epidural anesthesia, longer second stage of labor, and delayed time to first void (all p < 0.05).Absent bladder sensation was strongly associated with persistent PUR (89% vs. 8%, p < 0.001). Initial catheterization volume was significantly higher in the persistent group (median 1400 vs. 1000 mL, p < 0.001).In exploratory multivariable analysis, absent bladder sensation (OR 32.5, 95% CI 5.2-180.4) and catheterization volume >1200 mL (OR 8.4, 95% CI 2.1-33.7) were independently associated with persistent PUR. Catheterization volume demonstrated good discriminative ability (AUC ≈ 0.83) and was positively correlated with time to recovery (r = 0.63, p < 0.001), supporting its clinical relevance. CONCLUSION: Persistent PUR appears to be associated with impaired bladder sensation and bladder overdistension, supporting a combined neurogenic and myogenic pathophysiological mechanism. These findings highlight the importance of early postpartum bladder monitoring in preventing prolonged dysfunction.