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Updated: Dec 6, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
The impact of concomitant mid-urethral sling surgery on patients undergoing vaginal prolapse repair
Dominique Malacarne Pape1, Christina M Escobar2, Surbhi Agrawal1
1New York University Langone Medical Center, New York, NY, USA.
Introduction And Hypothesis:
The aim of this study was to assess whether mid-urethral sling (MUS) placement at the time of vaginal prolapse repair compared to vaginal prolapse repair alone is associated with an increase in 30-day postoperative complications.
Methods:
Using the American College of Surgeons National Surgical Quality Improvement Database, Current Procedural Terminology codes were used to identify cases of vaginal prolapse repair with and without concomitant MUS from 2012 to 2017. Student's t-test and chi-square test were used to compare differences between the groups.
Results:
A total of 1469 cases of vaginal prolapse repair with sling were compared to 4566 cases without sling. There was no difference between prolapse repair with sling compared to without sling in mean hospital length of stay (LOS) (1.42 versus 1.32 days, p = 0.65), postoperative urinary tract infection (UTI) (6.1% versus 5.8%, p = 0.670), perioperative blood transfusion (1.1% versus 1.2%, p = 0.673), readmission (2.7% versus 2.6%, p = 0.884) and postoperative wound infection (0.5% versus 0.7%, p = 0.51). There was a higher rate of reoperation (2.2% versus 1.5%, p = 0.049) and venous thromboembolism (VTE) (0.4% versus 0.1%, p = 0.030) in patients undergoing concomitant MUS compared to those undergoing prolapse repair alone.
Conclusions:
Compared to prolapse repair alone, the addition of a sling did not increase hospital LOS, UTI, perioperative blood transfusions, readmission or postoperative wound infections. However, concomitant sling was found to be associated with a higher risk of reoperation and VTE.
Insights
Adding a mid-urethral sling (MUS) during vaginal prolapse repair did not increase common complications. However, it was linked to higher risks of reoperation and venous thromboembolism (VTE).
Area of Science:
- Urogynecology
- Pelvic Reconstructive Surgery
- Surgical Outcomes Research
Background:
- Vaginal prolapse repair is a common procedure for pelvic floor disorders.
- The addition of a mid-urethral sling (MUS) during prolapse repair is a debated practice.
- Understanding the associated postoperative complication risks is crucial for patient counseling and surgical decision-making.
Purpose of the Study:
- To evaluate if concomitant mid-urethral sling (MUS) placement during vaginal prolapse repair increases 30-day postoperative complications compared to prolapse repair alone.
- To identify specific complications that may be associated with the combined procedure.
Main Methods:
- Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Database (NSQIP) from 2012 to 2017.
- Identification of patients undergoing vaginal prolapse repair with and without concomitant MUS using Current Procedural Terminology (CPT) codes.
- Statistical comparison of postoperative outcomes between the two groups using Student's t-test and chi-square test.
Main Results:
- A total of 6,035 cases were analyzed (1,469 with sling, 4,566 without).
- No significant differences were observed in hospital length of stay (LOS), postoperative urinary tract infection (UTI), perioperative blood transfusion, readmission, or wound infection rates.
- Concomitant MUS placement was associated with a higher rate of reoperation (2.2% vs 1.5%, p=0.049) and venous thromboembolism (VTE) (0.4% vs 0.1%, p=0.030).
Conclusions:
- The addition of a mid-urethral sling during vaginal prolapse repair does not increase the risk of common complications like UTI, transfusion, readmission, or wound infection.
- However, concomitant MUS placement is associated with an increased risk of reoperation and VTE.
- These findings suggest careful patient selection and counseling are warranted when considering combined prolapse repair and sling procedures.
