Incidence and Risk Factors of Postoperative Urinary Retention in Gynecologic Surgery: A Systematic Review and Meta-Analysis

Background: Postoperative urinary retention (POUR) is a frequent complication after gynecologic surgery, with wide variability in reported incidence due to differences in procedures and outcome definitions, and a lack of standardized quantitative synthesis. Objective: To estimate the incidence of POUR following gynecologic surgery and summarize associated risk factors and preventive strategies. Methods: A PRISMA-based systematic review and meta-analysis was conducted using PubMed, Scopus, EBSCO, and ScienceDirect. The review protocol was prospectively registered on the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/W8CYR). Random-effects models were applied to estimate pooled incidence, with subgroup analyses by procedure and POUR definition. Associated factors were synthesized narratively. Results: Thirty-four studies including 20,466 patients were analyzed. The pooled incidence of POUR was 16.1% (95% CI 12.8– 20.1; I 2 = 97.3%). Incidence was highest after pelvic organ prolapse surgery (30.9%) and sling/mid-urethral sling procedures (25.3%), and lowest after minimally invasive benign hysterectomy (3.7%). Increased risk was associated with baseline voiding dysfunction, diabetes mellitus, vaginal surgical approach, and opioid exposure, while minimally invasive techniques and selected perioperative strategies were protective. Conclusion: POUR is a common, procedure-dependent complication of gynecologic surgery. Procedure-specific risk stratification and standardized perioperative pathways are needed to reduce POUR and improve postoperative recovery. Keywords: postoperative urinary retention, gynecologic surgery, incidence, risk factors, meta-analysis