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Does Perineorrhaphy at the Time of Sacrocolpopexy Impact Voiding Trial Success?

Does Perineorrhaphy at the Time of Sacrocolpopexy Impact Voiding Trial Success?

Presenting Author(s)

Alyssa N. Sheedy, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Clarence, New York, United States

Co-Author(s)

Salma Attai, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Buffalo, New York, United States
EA

Ekhlas Abdulraheem, MBBCh (she/her/hers)

PGY-3 OBGYN Resident
Catholic Health, Sisters of Charity Hospital
Buffalo, New York, United States
AE

Abeer Eddib, MD

Urogynecologist
Kaleida Health
Getzville, New York, United States

Objectives: Perineorrhaphy is frequently performed as part of pelvic reconstructive procedures for the repair of pelvic organ prolapse in order to prevent recurrence of prolapse, reduce discomfort, improve sexual function and cosmesis. This study aims to investigate whether or not there is an impact on voiding trial success and post-operative pain in patients that had perineorrhaphy at the time of sacrocolpopexy (SCP).

Methods:

Design: Retrospective case control study

Setting: Academic-affiliated community hospital

Participants: All patients (N=783) undergoing robotic supracervical hysterectomy and sacrocolpopexy with transobturator midurethral sling placement by a single urogynecologist at a single institution between January 2012 and March 2023 were evaluated for impact of a perineorrhaphy at the time of these procedures on pain and voiding trials.

Interventions: Patients were stratified into two groups, patients that had a perineorrhaphy (n=579) and those who did not have a perineorrhaphy, controls (n=204) during the robotic assisted laparoscopic procedure.

Results: The perineorrhaphy group had slightly more obese patients with a mean BMI of 28.7 vs 27.1 in the non-perineorrhaphy group, p-value < 0.05. Comparison of other variables between the groups showed that perineorrhaphy patients had longer procedure times 127[99;154] vs 105[82;134] p< 0.05 and slightly higher but not statistically significant return to the emergency department 41(7.08%) vs 11(5.39%) OR (odds ratio) 0.76 [0.36;1.45] p=0.5.

The primary outcome of voiding trial success showed more failed postoperative voiding trials in the perineorrhaphy group 241(41.6%) vs the non-perineorrhaphy group 62(30.4%) p< 0.05.

The secondary outcome of pain between the perineorrhaphy vs the non perineorrhaphy group showed no difference between the groups. The perineorrhaphy patients had total pain MME(Morphine milligram equivalents) during admission of 15 [4.00;26.5] vs 15 [5.0;30.0] in the control group, OR (odds ratio) 1.0 [0.99;1.02] p=0.68.

Conclusions: Perineorrhaphy at the time of SCP had more voiding trial failure when compared to the control group. However, this could not be explained by pain alone as there was not a statistically significant difference in medication usage postoperatively. This is an important finding and needs further investigation to confirm and better understand the mechanism of perineorrhaphy effect on voiding function to help reduce the incidence of urinary retention.