Postoperative Urinary Retention: A Call for Objective Assessment and Standardized Postoperative Protocols.

Abstract

Postoperative urinary retention (POUR) is a common yet under-recognized source of preventable morbidity after pelvic and gynecologic surgery. Despite its frequency and clinical impact, postoperative bladder function is frequently assessed subjectively, based on patient-reported comfort or the observation of a single "apparently normal" void, rather than through objective post-void residual (PVR) measurement. Studies using postoperative bladder ultrasound have demonstrated that clinically significant residual volumes may occur in the absence of pain or urgency, and observational data associate POUR with urinary tract infection, prolonged or repeated catheterization, impaired recovery, and an increased likelihood of subsequent intervention. Surveys further reveal substantial variation in how clinicians and institutions assess and manage postoperative bladder retention, with no consensus regarding assessment timing, PVR thresholds, or recatheterization criteria, reflecting local practice patterns rather than consolidated standards. In this editorial, we argue that POUR should be regarded as a perioperative safety domain rather than a minor inconvenience, and that standardized postoperative bladder protocols incorporating objective assessment strategies, such as routine or risk-adapted bladder ultrasound and predefined escalation pathways, represent feasible, low-cost interventions associated with improved safety and operational clarity in postoperative care workflows.