(Poster 90) Post-surgical Urinary Retention: Uterosacral vs Sacrospinous Ligament Suspension

Objectives: We aim to compare rates of perioperative voiding dysfunction between uterosacral ligament suspension (USS) and sacrospinous ligament suspension (SSS) prolapse repair surgeries. We hypothesize that patients who undergo SSS will have higher rates of voiding dysfunction.

Methods: This study was a retrospective chart review of urogynecologic patients who underwent USS or SSS prolapse repair surgeries between January 1st, 2015 and February 14th, 2025. A power calculation resulted in a necessary sample size of at least 177 patients for each group. The primary outcome of interest was voiding trial (VT) result after surgery; pre-operative and peri-operative characteristics were also collected. A logistic regression controlling for significant variables was used to test the effect of POP surgery type on voiding dysfunction. A P-value of < 0.05 was considered statistically significant.

Results: A total of 763 patients who underwent prolapse repair surgery were analyzed: 577 with USS (75.6%) and 186 with SSS (24.4%). There was no significant difference in voiding dysfunction between these groups. When comparing isolated USS and SSS groups (excluding those with concomitant sling placement), patients who underwent USS had a VT fail rate of 26% compared to 31% for SSS (p = 0.1); this difference was not statistically significant (p = 0.3). Those with pre-operative SUI were more likely to fail the VT (22.1% vs 14.8%). Patients with pre-operative MUI were slightly more likely to pass the VT (35.8% vs 33.3%), contributing to an overall significant difference in pre-operative UI between groups (p = 0.028). Additionally, patients who failed the VT were more likely to have undergone a concomitant sling placement (54% vs 29.7%, p = < 0.001). Pre-operative anticholinergic use was also associated with greater voiding dysfunction (p = 0.049). Of note, patients were more likely to have a concomitant hysterectomy in the USS group and anterior/posterior repairs in the SSS group (p = 0.001).

Conclusions: While there are trends in voiding dysfunction between USS and SSS, these results were not statistically significant. Once clinical and demographic factors were controlled, no variables were found to be significant through regression analyses. The key driver for a failed VT and postoperative voiding dysfunction was the presence of concomitant sling placement. A study with a larger sample size of isolated USS and SSS surgeries (without sling placement) may be necessary to identify whether a difference in voiding dysfunction exists between these two apical suspension surgeries.