Does the Use of a Rigid Catheter Guide During Midurethral Sling Placement Impact Cystotomy Rates? A Retrospective...

To investigate whether the use of a rigid catheter guide in patients undergoing retropubic midurethral sling placement increases the incidence of cystotomy.

Patients who underwent a midurethral sling procedure performed using the bottom-up approach from January 2016 to December 2022 by a single fellowship-trained urogynecologist at a large community hospital were under study. The rate of bladder injury when this procedure was performed with the use of the rigid catheter guide was compared to the rate of bladder injury without the guide. The primary outcome was the incidence of cystotomy during the procedure identified by cystourethroscopy immediately following sling placement.

Overall, 472 patients underwent midurethral sling placement with the rigid catheter guide, and in 215 patients, the midurethral sling was placed without the rigid catheter guide. The incidence of bladder injury in cases with the rigid catheter guide was 12.9% (n = 61), and the incidence of bladder injury in cases without the rigid catheter guide was 10.2% (n = 22). This difference was not statistically significant (P = .316). Logistic regression demonstrated a statistically significant relationship between BMI and cystotomy (P = .041). For every 1-point increase in BMI, the incidence of bladder injury decreased by 4.2%.

The use of a rigid catheter guide in midurethral sling placement was not found to be associated with a decrease in cystotomy rates. Increasing BMI was found to be protective against bladder injury during the midurethral sling procedure.