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Second Sling Impact on Immediate Postoperative Voiding Function in Patients with Previous Sling

Second Sling Impact on Immediate Postoperative Voiding Function in Patients with Previous Sling

Presenting Author(s)

Salma Attai, BS

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

Co-Author(s)

IA

Ismail Attuwaybi, BS

Student
University at Buffalo
Buffalo, New York, United States
Alyssa N. Sheedy, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Clarence, New York, United States
Janine A. Meurer, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences
Buffalo, New York, United States
AE

Abeer Eddib, MD

Urogynecologist
Kaleida Health
Getzville, New York, United States

Objectives: Patients who have undergone previous sling procedures occasionally present with symptomatic pelvic organ prolapse and incontinence. They subsequently undergo surgery that includes the placement of a second sling in addition to the original sling. There is limited data on the impact of second sling procedures on perioperative outcomes. The aim of this study is to evaluate the impact of a 2nd or 3rd sling on voiding function and other perioperative outcomes.

Methods:

Design: Retrospective case control study

Setting: Academic-affiliated community hospital

Patients or Participants: All patients (N=1247) undergoing robotic sacrocolpopexy with transobturator midurethral sling by a single urogynecologist at a single institution between January 2012 and March 2023. The patients were evaluated for impact of a second sling during these procedures in patients that have had a previous sling. The outcomes of interest are postoperative pain and voiding function.

Interventions: Patients were grouped as controls who had a sacrocolpopexy (SCP) and sling without a prior sling procedure (N=1178) and grouped as cases (N=69) that had a sling procedure prior to the index surgery.

Results: The demographics between the cases (previous sling) and controls (no previous sling) were similar except that the case group had slightly more obese patients than the control group with a mean BMI of 30.6 vs 28.3 (p< 0.05). Comparison of other variables between groups showed the previous sling group were more likely to have had a previous hysterectomy (54 (78.3%) vs 413 (35.1%), (p< 0.05)).

There was no difference in voiding trial success between the cases 31(44.9%) and controls 479(40.7%) or 0.68 [0.38;1.20], (p=0.22). The mean postvoid residual volume (PVR) in the previous sling group was 130 [64.5;234] and the control group was 159 [55;253], (p=0.7) with no statistical difference. There was also no statistical difference in length of hospital stay, return to the emergency department, or readmission.

Conclusions:

Conclusion: There is no statistical difference in voiding function based on the postoperative voiding trial, between patients who have had a sling surgery prior to SCP and sling procedure compared to patients who have not had a sling procedure prior to SCP and sling procedure. Further investigation into long term outcomes may be beneficial to help ensure safety of a second sling in these situations.