(Poster 53) Urinary Retention Rates Between Midurethral Slings with Different Sleeve Designs

Objectives: Midurethral slings are currently the gold standard for surgical management of stress urinary incontinence. A midurethral sling uses polypropylene mesh to support the urethra and decrease leakage with efforts. One of the most common complications of a sling is post-op urinary retention. Prior to June 27th, 2022, one surgeon utilized a sling with sheaths that did not overlap (MUS). After June 27th, 2022, this surgeon switched to a sling with sheaths that overlapped at the midline (MUSOV). This study evaluated the post-op urinary retention rates between the two sheath insertion systems.

Methods: A total of 399 charts were flagged with the billing code 57288.A for a midurethral sling procedure between June 27th, 2021 and June 26th, 2023 by one surgeon. Each chart was reviewed to document: Type of sling , concomitant surgical procedures, pass/fail status of post-op day #1 bladder trial , and rates of post-op UTI or midurethral sling revision. A T-test was used to analyze the differences between MUS and MUSOV groups. A Chi square test was used to analyze the associations between variables.

Results: There were significantly higher rates of failed bladder trials in the MUS group compared to the MUSOV group, as noted in Table 1. Figure A represents the frequency of types of hysterectomy or other procedures completed at the time of midurethral sling placement. Native tissue repairs and vaginal hysterectomies occurred at a significantly higher frequency in the MUS group.

Conclusions: Our data showed a statistically significant correlation between having a MUS and failed POD#1 voiding trials when compared to those who had a MUSOV. While the midurethral slings themselves are the same product, the system to place the sling is different and may be the link between these two findings. However, it is also important to note that vaginal hysterectomies and native tissue repairs occurred at a significantly higher frequency in the MUS group compared to MUSOV. More instrumentation in the vagina at time of the midurethral sling placement could be a confounding variable when evaluating the results of the post-op voiding trial. Further analysis of voiding trial results compared to vaginal hysterectomies and native tissue repairs is needed to determine how influential these factors are.
The MUS was associated with a higher rate of failed post-op voiding trials requiring discharge home with a foley catheter when compared to MUSOV. Vaginal hysterectomy and native tissue repairs were more frequent in the MUS group compared to MUSOV, and therefore could represent confounding variables in this study and would require further investigation to determine their influence on post-op bladder function.
Figure A Legend: Blue represents MUS, purple represents MUSOV