[Mid-uretral retropubic TVT sling procedure complicated by intraoperative cystotomy (bladder injury): Is it possible to avoid postoperative indwelling catheter?]
Related Experiment Video
Updated: Apr 24, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
V Canel1, T Thubert2, I Wigniolle1
1Service de gynécologie-obstétrique et médecine de la reproduction, GHU-Sud, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris (AP-HP), 92141 Clamart, France.
Objective:
Retropubic mid-uretral sling (MUS) procedure may be complicated by bladder injury (intraoperative cystotomy). There is no scientific consensus on the length of catheter drainage following bladder injury during MUS procedure: it varies from hours to days. We have made it our policy to immediately remove the catheter. The objective of the current study was to assess the results associated with immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure.
Methods:
Retrospective case-control study. Group 1 (cases): 8 women who have experienced bladder injury during retropubic MUS procedure and group 2 (controls): 32 women (ratio of controls to cases: 4:1).
Results:
Mean (sd) age, BMI and MUCP were 62(13) vs. 59(10), 25(4) vs. 26(4) and 42(18) vs. 43(16), in group 1 and group 2, respectively (P=0.55, 0.56 and 0.92). Minimum follow-up duration was 12 months. None patient was lost to follow-up in group 1 (cases) and 2 patients were lost to follow-up in group 2 (controls) at 12 months follow-up. No rehospitalization or postoperative complication was noted in both groups. Immediate suprapubic postoperative pain exceeding 30/100 on VAS occurred in 1/8 (12%) and 3/32 (10%), in group 1 and group 2, respectively (P=1.00). Urinary stress incontinence cure rates were not significantly different between the two groups: 8/8 (100%) vs. 28/32 (87%), in group 1 and group 2, respectively (P=0.56). The level of satisfaction was comparable in both groups: PGI-I score was equal to 1(very satisfied) in 6/8 women (75%) and in 24/32 women (75%), in group 1 and group 2, respectively (P=1.00). De novo urgency was observed in 0/8 (0%) vs. 3/32 (10%), in group 1 and group 2, respectively (P=1.00).
Conclusion:
In the current short retrospective series, immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure was not associated with an increased prevalence of complications.
Level Of Evidence:
4.
Insights
Immediate catheter removal after bladder injury during retropubic mid-urethral sling (MUS) procedures is safe. This approach did not increase complications or affect cure rates for stress incontinence.
Area of Science:
- Urology
- Gynecology
- Surgical Complications
Context:
- Retropubic mid-urethral sling (MUS) procedures are common for treating stress urinary incontinence.
- Bladder injury (intraoperative cystotomy) is a potential complication during MUS.
- Current practices for post-cystotomy catheter drainage duration vary widely, lacking a standardized approach.
Purpose:
- To evaluate the safety and efficacy of immediate catheter removal following intraoperative bladder injury during retropubic MUS.
- To compare outcomes between patients with immediate catheter removal and those with standard drainage durations.
Summary:
- A retrospective case-control study compared 8 women with immediate catheter removal (cases) to 32 women with standard drainage (controls) after bladder injury during MUS.
- No significant differences were observed in rehospitalization, postoperative complications, pain, stress incontinence cure rates (100% vs. 87%), or patient satisfaction.
- De novo urgency was comparable (0% vs. 10%).
Impact:
- Immediate catheter removal following intraoperative bladder injury during retropubic MUS appears to be a safe and effective management strategy.
- This finding supports a potential shift towards earlier catheter removal, possibly reducing hospital stay and patient discomfort.
- Further prospective studies are warranted to confirm these findings in larger cohorts.
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