Postoperative Voiding Function After Total Laparoscopic Hysterectomy with Transvaginal Versus Transabdominal Morcellation

Objective: This study examined postoperative urinary retention (POUR) rates in patients who had transvaginal or transabdominal morcellation for large fibroids or adenomyotic uteri.Materials and Methods: This retrospective, observational cohort study was conducted, from January 2015 to April 2021, in a multicenter health care system, in Calgary and Southern Alberta, Canada. The patients were women, >= 18 years, who had total laparoscopic hysterectomy with morcellation. Women with preexisting urinary retention were excluded. POUR was urinary retention needing an indwelling or in-and-out catheter postoperatively before discharge.Results: There were no differences in POUR for transvaginal (29/139; 20.9%) and transabdominal (12/56; 21.4%) morcellation. There were also no differences in time to first postoperative void (5.5 hours [range: 3.5-8] versus 5.75 hours [range: 4-7.125]); length of stay (23 hours [range: 20.875-25.625] versus 22 hours [range:18.5-24.5]); postoperative urinary tract infections (5.1% versus 3.6%); or visits to the emergency department for POUR postdischarge (1.4% versus 1.8%) for transvaginal and transabdominal morcellation, respectively. The vaginal-morcellation group trended toward increased complication rates during morcellation (7% versus 0%) and urinary complaints at postoperative follow-ups (9.4% versus 0%).Conclusions: Either morcellation type produces similar rates of POUR. Surgeon and patient preferences guide decisions on preferred morcellation routes. Larger prospective trials are needed to further assess POUR, potential for increased complications, and postoperative urinary complaints induced by transvaginal morcellation. (J GYNECOL SURG 20XX:000)