Postoperative Management of Bladder Perforation During Mid-Urethral Sling Procedures

There is no clear consensus on managing bladder perforation after mid-urethral sling placement. Traditional use of an indwelling catheter can be frustrating. This study evaluates the difference in fistula rates between patients managed with and without continuous bladder drainage.

A retrospective chart review of women who underwent mid-urethral sling procedures in an academic center between the years 2017 and 2023 was completed. All cases of bladder perforation detected upon intraoperative cystoscopy were included in this cohort. Patient information, including demographics, clinical data, and perioperative factors, including operation type and postoperative catheter use, were extracted from electronic medical records. Descriptive statistics were performed.

Out of a total of 1702 women who underwent mid-urethral sling procedures, 97 had bladder perforations confirmed by cystoscopy. Of these, 96 had retropubic slings, and 1 had a transobturator sling. There were 67 patients who also had concomitant pelvic organ prolapse repair, whereas 30 patients did not have any concomitant procedures. Of the cohort, 61 patients were discharged on the same day as the surgery without a catheter, whereas 36 had continuous bladder drainage with an indwelling catheter postoperatively. None of the patients developed fistulas in our study cohort. Postoperative adverse outcomes, including recurrent urinary tract infection, mesh exposure, and urinary retention were similar in the two groups (p > 0.05).

Immediate postoperative catheter removal does not appear to be an unsafe practice compared with continuous postoperative urinary catheterization following bladder perforation as a result of sling trocar placement.