To investigate the efficacy of low-frequency electrical stimulation (LFES) of the bladder and its combination with acupuncture in the treatment of postoperative urinary retention (POUR) following pelvic organ prolapse(POP) surgery.

This was a single-center retrospective cohort study. A total of 817 patients who underwent pelvic floor reconstructive surgery or colpocleisis in the Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, from January 2018 to December 2025 were enrolled. Among them, 90 patients were selected as study subjects who developed POUR after indwelling catheterization for 48-72 hours postoperatively, characterized by dysuria, poor urinary flow, post-void residual urine volume (PVR)≥100 ml, or inability to void spontaneously requiring re-catheterization. Treatment modalities were selected by physicians based on disease conditions and patient preferences. According to the treatment methods, patients were divided into four groups: indwelling catheterization group (n=34), LFES+indwelling catheterization group (n=31), acupuncture+LFES+indwelling catheterization group (n=21), and indwelling catheterization+acupuncture group (n=4). Successful initial treatment was defined as PVR<100 ml after catheter removal 48 hours post-treatment. The general characteristics of POUR patients, influencing factors of initial treatment efficacy, and treatment outcomes among groups were analyzed.

The mean age of the 90 POUR patients was (68.7±7.9) years. All patients had pelvic organ prolapse quantification (POP-Q) of stage Ⅲ-Ⅳ, including 83 cases (92.2%) of anterior pelvic prolapse; 84 cases (93.0%) had preoperative urinary retention. The acupuncture + indwelling catheterization group included only 4 completed cases and discontinued study without comparative analysis. Among the remaining three groups, the acupuncture+ LFES+ indwelling catheterization group had significantly higher proportions of patients with longer preoperative urinary retention duration, POP-Q stage Ⅳ, vaginal closure surgery, concurrent hysterectomy, or tension-free vaginal tape (TVT) procedure than the indwelling catheterization group and LFES+indwelling catheterization group (P<0.05). The overall initial treatment success rate of the three groups was 80.2% (69/86). Compared with the initial treatment success group, the failure group had a higher median PVR and longer catheter indwelling time, with statistically significant differences (P<0.05). All patients in the failure group had the most severe prolapse at the anterior pelvic compartment, which was higher than 89.9% in the success group, but the difference was not statistically significant (P>0.05). All patients with initial treatment failure recovered after subsequent LFES combined with acupuncture treatment. The initial treatment success rates of the indwelling catheterization group, LFES+indwelling catheterization group, and acupuncture+LFES+indwelling catheterization group were 88.2% (30/34), 77.4% (24/31), and 71.4% (15/21), respectively, with no statistically significant difference (P=0.279).

Severe anterior pelvic prolapse (POP-Q stage Ⅲ-Ⅳ) with long-term urinary retention, advanced age and poor physical condition, and complex pelvic floor surgery may be high-risk factors for POUR. High PVR and prolonged catheter indwelling time may affect treatment efficacy. The combined therapy of LFES, acupuncture and indwelling catheterization achieves comparable efficacy in patients with severe POUR to that of simple catheterization and LFES plus catheterization in patients with mild POUR. However, this conclusion still needs to be further verified by multicenter prospective randomized controlled trials.