Risk Factors for Bladder Perforation at the Time of Retropubic Midurethral Sling Placement

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Surgical Complications

Background:

• Conflicting evidence exists regarding predictive factors for bladder perforation during retropubic midurethral sling (R-MUS) placement.
• There is a lack of evidence supporting techniques to minimize such injuries.

Purpose of the Study:

• To determine the incidence of and factors associated with bladder perforation during R-MUS placement.
• To evaluate if retropubic hydrodissection reduces the likelihood of bladder perforation.

Main Methods:

• A case-control study involving 1,187 women undergoing R-MUS placement between 2007 and 2017.
• Cases with bladder perforation were matched 1:3 with controls without perforation based on surgeon, sling type, and surgery date.
• Operative reports were reviewed to identify bladder perforations.

Main Results:

• The incidence of bladder perforation was 8% (92/1,187 patients).
• Patients with bladder perforation were more likely to have a body mass index (BMI) < 30 and a diagnosis of endometriosis.
• Retropubic hydrodissection was performed in 62% of patients but was not associated with a lower risk of perforation.

Conclusions:

• The incidence of bladder perforation during R-MUS is 8%.
• A BMI < 30 and endometriosis are significant risk factors for bladder perforation.
• Retropubic hydrodissection does not appear to decrease the likelihood of bladder perforation during R-MUS placement.