Comparing Postoperative Urinary Retention Rates between Robotic Prolapse Repair Surgeries

Objectives: The aim of our study is to compare the post-operative urinary retention rates after pelvic organ prolapse (POP) repair between robotic transabdominal approaches.

Methods: We conducted an IRB-exempt retrospective chart review of patients who underwent POP repair with robotic sacrocolpopexy (RSCP) and robotic uterosacral ligament suspension (RUSLS) procedures between June 2018 to March 2022. Our primary outcome was the rate of acute post-operative urinary retention in these two groups, defined as post-void residual greater than one-third of pre-voided volume after an active or passive void trial. Secondary outcomes were the number of days needed to resolve urinary retention and persistent voiding dysfunction. Student T-test and Mann-Whitney U test were used for continuous variables and Chi-square test was used for categorical variables. Multivariate analysis using logistic regression was used to obtain odds ratio (OR).

Results: 298 patients underwent POP repair with robotic transabdominal approaches; 258 underwent RSCP and 40 underwent RUSLS. Acute post-operative urinary retention was found in 73 patients (24%); 46 patients (18%) in RSCP group versus 26 patients (65%) in RUSLS group (p< 0.001). Multivariate analysis demonstrated that there was a significantly higher rate of acute post-operative urinary retention after RUSLS (OR=17.92, CI 3.06-104.86; p=0.001). Patients with elevated pre-operative post-void residual (PVR) >100 or concomitant midurethral sling were more likely to develop post-operative urinary retention (OR=2.93 CI 1.43-5.98; p=0.003 and OR=2.19 CI 1.16-4.14; p=0.016, respectively). While patients with higher parity are less likely to have urinary retention (OR=0.71 CI 0.53-0.96; p=0.024), age, body mass index (BMI), prolapse stage and concurrent posterior repair did not affect the urinary retention rate significantly. The number of days needed to resolve urinary retention and persistent voiding dysfunction were similar between the groups.

Conclusions: Acute post-operative urinary retention appears more likely to develop after robotic uterosacral ligament suspension compared to robotic sacrocolpopexy. Elevated pre-operative PVR and concomitant midurethral sling independently increase the risk of urinary retention.