Accuracy of urethral swab and urine analysis for the detection of Mycoplasma hominis and Ureaplasma urealyticum in women with lower urinary tract symptoms.

OBJECTIVES: Our objective was to evaluate and compare the accuracy of urethral swabs and urine specimens in the detection of Mycoplasmas in women with lower urinary tract symptoms (LUTS). METHODS: During a urogynecological work-up, including cystometry, we obtained first-void urine, urethral and vaginal swabs in 207 consecutive women at our urogynecological division. Mycoplasma hominis and Ureaplasma urealyticum as well as other microorganisms were detected by standard culture methods. RESULTS: 131 of 207 women reported LUTS. The other 76 formed the controls. Of 207 women 50 (24.2%) had positive cultures for Mycoplasmas. The prevalence of Mycoplasmas in women with LUTS (30.3%) was statistically significant and higher in the group without LUTS (14.5%) (p = 0.011). The detection of M. hominis was most accurate using urethral swab (Specificity 99.9%, PPV 99.6%) compared to the urine specimen (96%, 75%) and vaginal swab (95.1%, 67%). Similar results could be achieved for U. urealyticum (urethral swab: specificity 98.7%, PPV 96.3%; urine specimen: 86.8%, 72%; vaginal swab: 80.5%, 65.2%). CONCLUSION: In the subgroup of women less than 50 years an (detectable) infection due to Mycoplasma or Ureaplasma leads typically to LUTS with normal filling cystometry, whereas no such findings were relevant for the elderly women.

Risk factors in prolonged postpartum urinary retention: an analysis of six cases.

PURPOSE: Prolonged first and second stage of labor, isolated prolongation of the second stage, forceps delivery or vacuum extraction, perineal laceration, nulliparity and epidural anesthesia are known risk factors for developing prolonged postpartum urinary retention (PUR). The aim of our study was to analyze number and constellations of these risk factors, in prolonged postpartum urinary retention (PPUR) in our own unit to facilitate the identification of patients at high risk and thus to prevent bladder overdistension by early intervention. METHODS: We performed a retrospective analysis of all our cases with PPUR between 2003 and 2008 including variables like age weight, height, body mass index, fetal birth weight and head circumference. RESULTS: The incidence of PPUR at our institution is low being 0.06%. No woman combined all six risk factors. The majority had five risk factors, all had at least four. An isolated prolonged second stage of labor was common to all patients with PPUR. Five women had an epidural anesthesia, three were nulliparous and only two women delivered spontaneously. All but one woman suffered from perineal tears. Interestingly, fetal head circumference was larger than 36 cm in four of six cases. CONCLUSION: In contrast to simple PUR, the prolonged form of PUR could be the result of a cumulative effect of different single risk factors.

Prolonged postpartum urinary retention: the importance of asking the right questions at the right time.

The pathophysiology of postpartum urinary retention (PUR) is still unclear. The prevalence rate varies with the definition used and the literature discusses various risk factors. Bladder catheterization is the treatment of choice, but the best way to do it is not ascertained. Long-term sequelae seem to be rare. There are no widely accepted preventive measures. Our 2 cases illustrate that it is important to prevent PUR not only by avoiding the known risk factors, but also by additionally asking for signs of voiding dysfunction postpartum.

Recurrent postpartum urinary retention: a case report.

Postpartum urinary retention (PUR) is a clinical condition that is neither well-recognized nor defined by standardized means but normally has a good prognosis. We present the case of a woman with a history of PUR who demonstrated recurrent PUR. Prolonged first and second stage of labor, isolated prolonged second stage of labor, forceps delivery or vacuum extraction, perineal laceration, nulliparity and epidural anesthesia can act as independent risk factors for the development of PUR. In this case, epidural anesthesia, which was administered in both deliveries, was the only risk factor, suggesting that its application in a woman with a history of PUR should be carefully considered and discussed with the patient. Bladder drainage resolves PUR, after which there seems to be no cumulative risk for voiding dysfunction. An initial smaller post-void residual bladder volume may have a predictive value concerning the time to resolution of PUR.