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Postoperative Management of Bladder Perforation During Mid-Urethral Sling Procedures
Emir Gurbuz1, E Cansu Cevik1, Savci Bekir Telek1
1Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, Yale School of Medicine, New Haven, CT, USA.
International Urogynecology Journal
|June 17, 2025
Summary
Immediate removal of urinary catheters after bladder perforation during mid-urethral sling surgery is safe. This approach avoids prolonged catheterization and does not increase fistula rates or other complications.
Area of Science:
- Urology
- Gynecology
- Female Pelvic Medicine
Background:
- Bladder perforation during mid-urethral sling procedures lacks a consensus management strategy.
- Traditional indwelling catheterization can cause patient discomfort and frustration.
Purpose of the Study:
- To evaluate fistula rates in patients managed with or without continuous bladder drainage after iatrogenic bladder perforation during mid-urethral sling surgery.
Main Methods:
- Retrospective chart review of women undergoing mid-urethral sling procedures (2017-2023).
- Inclusion of all cases with intraoperatively confirmed bladder perforation.
- Comparison of outcomes between patients discharged without a catheter versus those with continuous bladder drainage.
Main Results:
- Out of 1702 sling procedures, 97 cases of bladder perforation were identified.
- No fistulas developed in any patients, regardless of postoperative catheter management.
- Similar rates of adverse outcomes (UTI, mesh exposure, retention) were observed between groups.
Conclusions:
- Immediate postoperative catheter removal is a safe alternative to continuous catheterization for bladder perforation during sling placement.
- This management strategy does not increase the risk of fistula formation.
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