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Vessel-sparing Excision and Primary Anastomosis

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Comparing Postoperative Urinary Retention Rates Between Robotic Apical Prolapse Repairs.

Kaythi Khin¹, Shaun T Adair, Laura Dhariwal

¹From the Division of Urogynecology and Reconstructive Pelvic Surgery, Atlantic Health System, Morristown, NJ.

Urogynecology (Philadelphia, Pa.)

|May 10, 2024

Summary

Robotic uterosacral ligament suspension (RUSLS) for pelvic organ prolapse repair is associated with a higher risk of postoperative urinary retention (POUR) compared to robotic sacrocolpopexy (RSCP). Elevated postvoid residual volume and midurethral slings increase POUR risk.

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Area of Science:

Urogynecology
Minimally Invasive Surgery
Pelvic Floor Disorders

Background:

Urinary retention after pelvic organ prolapse (POP) surgery impacts patient outcomes and requires careful perioperative counseling.
Different surgical approaches for POP repair may carry varying risks of postoperative urinary retention (POUR).

Purpose of the Study:

To compare the rates of acute postoperative urinary retention (POUR) between robotic sacrocolpopexy (RSCP) and robotic uterosacral ligament suspension (RUSLS).

Main Methods:

A retrospective cohort study compared 298 patients undergoing RSCP (n=258) or RUSLS (n=40) for POP repair.
The primary outcome was the incidence of acute POUR.
Secondary outcomes included time to resolution of urinary retention and persistent voiding dysfunction.

Main Results:

The overall acute POUR rate was 24%, with significantly higher rates after RUSLS (65%) compared to RSCP (18%) (P < 0.001).
Multivariate analysis confirmed RUSLS as a significant independent predictor of POUR (OR = 17.92).
Elevated preoperative postvoid residual volume (>100 mL) and concomitant midurethral sling placement were also independent risk factors for POUR.

Conclusions:

Robotic uterosacral ligament suspension (RUSLS) is associated with a substantially higher risk of acute postoperative urinary retention compared to robotic sacrocolpopexy (RSCP).
Preoperative elevated postvoid residual volume and concurrent midurethral sling surgery are significant risk factors that independently increase the likelihood of developing POUR.