(Poster 179) Iatrogenic Urinary Retention After Transobturator Sling: Comparison of Brands

Objectives: Synthetic midurethral slings (MUS) are the most common surgical treatment for stress urinary incontinence (SUI) in females. Compared to the retropubic approach, transobturator (TOT) sling approach has similar efficacy but fewer rates of injury to bladder, bowel, and major vessels. However, the potential complication of iatrogenic outlet obstruction persists. Three months has been traditionally defined as the period in which one would expect spontaneous resolution of iatrogenic urinary retention following a sling procedure. After this period, persistent retention is rare, but surgical intervention is typically warranted. Little data exists comparing the rate of postoperative urinary retention between TOT sling brands.

Methods: This is a retrospective cohort study spanning two time periods (2017-2019 and 2021-2023). We compiled pertinent patient data among patients who underwent a transobturator midurethral sling (MUS) procedure for stress urinary incontinence (SUI) at a single community hospital. We compared two cohorts of patients: (1) patients who underwent a TOT MUS procedure from 2017-2019 with the Desara (Caldera) sling and (2) those who had the procedure from 2021-2023 when the practice transitioned to the Obtryx II (Boston Scientific) sling. Patients who underwent a TOT MUS procedure during the year 2020 were not included to allow for a wash-out period.

Our primary outcome was the rate of iatrogenic persistent postoperative urinary retention, defined as requiring reoperation within 90 days of transobturator sling placement. Our secondary outcomes were rates of short-term urinary retention, defined as discharge with an indwelling transurethral catheter or clean intermittent catheterization for immediate postoperative urinary retention.

Results: For the cohort spanning 2021-2023 (Boston Scientific), there were a total of 530 sling procedures at our institution. Out of this sample, 27 sling revisions were performed. Next, we will compare these numbers to the cohort spanning 2017-2019 (Caldera). For both cohorts, we will also look at our secondary objective by comparing rates of short-term urinary retention. Additional variables of interest being collected include race, ethnicity, primary language, highest education level, BMI, and co-morbid health conditions (others in secondary objectives above), concomitant procedures, and attending surgeon.

Conclusions: Conclusions pending final results.