Inte rnati on al Urogynecology Journal (2020) 31: 529-533 https :/ l doi. orgl 1 0. 1007 ls001 92-01 9-0401 o-y ORIGINAL ARTICLE Risk factors for overt postpartum urinary retention-the effect of the number of catheterizations during labor Check for updates Maia Rosenberg 1 ·Ariel Many 2 • Shiri Shinar 3 8 Recei ved: 18 April 2 01 9 I Accepted: 30 May 2019 I Pu blished on line: 20 Jun e 2019 © The International U rogynecol og ical Associati on 2019 Abstract Introduction and hypothesis Our aim was to examine the effect of the number of catheterizations during labor on the develop- ment of overt postpartum urinary retention (PUR) in women who had a vaginal delivery with epidural anesthesia. Methods A single-center retrospective matched case-control study between 1 January 2015 and 31 December 2016. Women who developed overt PUR were compared with those who did not following a singleton vaginal delivery with epidural anes- thesia. For each study two controls, matched for maternal age, gestational age at delivery, and parity, were selected. Each woman's controls were the immediate subsequent or previous delivery that met matching criteria. Results Two hundred parturients with overt PUR were matched with 400 parturients without overt PUR. In univariate analysis, women with PUR underwent significantly more catheterizations during labor, had an epidural for a longer period of time, and were more likely to have undergone a vacuum-assisted delivery and a mediolateral episiotomy (p < 0.01 for all). 1n multivariate analysis contro lling for epidural duration, episiotomy, and vacuum-assisted delivery, the risk of PUR among women with at least two catheterizations was greater when fewer catheterizations were performed (OR = 0.78, 95 % CI 0.61--{).99). When controlling for the number of catheterizations overall, episiotomy, and vacuum-assisted delivery, PUR risk significantly increased with a longer epidural duration (OR 1.23, 95% CI 1.17- 1.29). Episiotomy and vacuum-assisted delivery had no significant effect on PUR. Conclusions The risk of PUR decreases as the number of catheterizations increases. Although longer epidural duration indepen- dently increases the risk of PUR, episiotomy and vacuum-assisted delivery do not. Keywords PUR · Postpartum urinary retention · Risk factor · Epidural · Catheterization Introduction Postpartum urinary retention (PUR) is a common complica- tion, occurring in 1.5 % to 45 % of parturients [1]. It is associ- ated with short- and long-term morbidity, such as increased risk for upper and lower urinary tract infections and irrevers- ible detrusor damage with prolonged voiding dysfunction, in cases left undiagnosed and untreated [2]. 181 Shiri Shinar shiri .shinar @s inaihealthsystem. ca; Shirishinarl @gmail.com Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto , Toronto, ON, Canada Previous stu dies have shown that acute PUR is associated with epidural anesthesia [3]. The effect of epidural appears to be mediated through other risk factors of labor and delivery, including nulliparity [ 4-6], instrumental delivery [5- 7], vagi- nal or perineal trauma, and a prolonged second stage oflabor [8- 1 0]. With increasing prevalence of epidural anesthesia and instrumental deliveries [9], PUR is becoming a more pertinent and widespread complication. At present, there are no recommended guidelines for intrapartum bladder management for women with an epidural catheter. Subsequently, there has been a wide variation in bladder care, both intrapartum and postpartum, across mater- nity units worldwide [2]. In an attempt to better understand risk factors for overt PUR among parturients who undergo intermittent catheterization, we aimed to examine the effect of the number of catheterizations during labor and volume emptied with each catheterization on the development of overt PUR in women who had a vaginal delivery with epidural