Foley catheter guide use during midurethral slings: does it make a difference?

Area of Science:

• Urology
• Gynecology
• Surgical Innovation

Background:

• Retropubic midurethral sling placement is a common procedure for stress urinary incontinence.
• Intraoperative lower urinary tract injury, such as cystotomy, is a known complication.
• The use of a foley catheter guide as a preventative measure has been proposed.

Purpose of the Study:

• To evaluate the effectiveness of a foley catheter guide in reducing the incidence of cystotomy and urethrotomy during retropubic midurethral sling placement.
• To compare complication rates between patients who underwent the procedure with and without a foley catheter guide.

Main Methods:

• Retrospective cohort study of 310 women undergoing retropubic synthetic midurethral sling placement.
• Patients were stratified based on the use of a foley catheter guide during surgery.
• Primary outcome measured was the incidence of cystotomy; urethrotomy was also monitored.

Main Results:

• A total of 310 patients were included; 24.5% had the foley catheter guide used.
• Fourteen patients (4.5%) experienced cystotomies, with 1.3% in the guide group and 5.6% in the no-guide group (p=0.12).
• Logistic regression analysis, after adjusting for confounding factors, showed no significant difference in cystotomy odds between the groups (AOR = 0.2 [95% CI 0.02-1.7]).

Conclusions:

• Foley catheter guide use did not demonstrate a statistically significant reduction in the risk of intraoperative lower urinary tract injury during retropubic midurethral sling placement.
• The study suggests that current evidence does not support routine use of the foley catheter guide for preventing cystotomy.
• Larger prospective studies are recommended to definitively confirm these findings and explore other potential preventative strategies.