Comparison of Cystotomy in Midurethral Sling Procedure With and Without a Rigid-Catheter Guide

Presenting Author(s)

Alessandra M. Jannette, DO, MS (she/her/hers)

Resident Physician
Ascension St. John
Grosse Pointe Woods, Michigan, United States

Co-Author(s)

MM

Mehnaaz Mohammed, BS (she/her/hers)

Medical Student
Wayne State University
Harper Woods, Michigan, United States
MA

Muhammad Faisal Aslam, MD, FACOG, FRCOG

FPMRS Attending Physician
Ascension St. John
Detroit, Michigan, United States
TS

Tamara Siblini, MD

Resident Physician
Ascension St. John

Objectives: The purpose of this study is to identify the incidence of bladder injury in retropubic mid-urethral sling (MUS) performed using the bottom-up approach both with and without rigid catheter guide.

Methods: This was a single-center retrospective cohort study comparing the rate of bladder injury when mid-urethral sling procedure was performed with a rigid-catheter guide versus when performed without a rigid-catheter guide. Included patients had a retropubic mid-urethral sling procedure performed using the bottom-up approach from January 2016 to December 2022 by a single FPMRS surgeon. The primary outcome was incidence of cystotomy during sling procedure as identified by cystourethroscopy immediately following placement. Concurrent surgeries performed, timing of mid-urethral sling placement relative to concomitant procedures, and use of rigid catheter guide was recorded for each patient. Baseline patient demographics were recorded via chart review. Data were analyzed using the student’s t-test, chi-squared test, and stepwise logistic regression.

Results: In our study group, 68.7% of patients (472/687) had MUS placed with a rigid catheter guide and 31.3% (215.687) without a rigid-catheter guide. The rigid-catheter guide patients had a lower mean age, 60.0 ± 12.3 vs. 62.3 ± 12.8 years, respectively (p=0.02). Patient BMI, parity, smoking status, menopausal status, history of abdominal surgery, and co-morbid conditions such as hypertension, hyperlipidemia, asthma and diabetes did not differ significantly between each group.

The incidence of cystotomy in patients with the rigid-catheter guide was 10.2% (n=22) and the incidence of cystotomy in patients without the rigid catheter guide was 12.9% (n=61). This difference was not statistically significant (p=0.3)

From multivariable logistic regression using a forward stepwise likelihood ratio algorithm and including variables associated with bladder injury and rigid catheter, we found that for every one unit increase in BMI, the risk of bladder injury decreased by 4.2% (OR=0.96, p=0.04).

Conclusions: Mid-urethral sling was an effective and safe treatment for stress urinary incontinence. There was no significant difference in cystotomy when a rigid-catheter guide is used. Increasing BMI was protective against bladder injury during mid-urethral sling placement.