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

Viviana Casas-Puig1, C Emi Bretschneider, Mark D Walters

  • 1From the Center for Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH.

Female Pelvic Medicine & Reconstructive Surgery
|June 28, 2022
PubMed
Abstract

Insights

Bladder perforation during retropubic midurethral sling (R-MUS) placement occurs in 8% of patients. Lower BMI and endometriosis increase risk, while hydrodissection offers no significant protection.

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.

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