Perineoplasty, Pain, and Urinary Retention Following Native Tissue Vaginal Prolapse Surgery

Perineoplasty is commonly performed at the time of pelvic reconstructive surgery. Data on the immediate postoperative complications from perineoplasty are sparse.

Perineoplasty performed at the time of vaginal prolapse surgery increases postoperative urinary retention and pain.

We conducted a retrospective cohort study on patients undergoing vaginal prolapse surgery with or without perineoplasty from 2014-2023 at an academic institution. Demographics, intra and postoperative characteristics, including pain scores, medical comorbidities, and surgical procedures performed, were compared. Postoperative urinary retention was defined as failing a retrograde voiding trial necessitating discharge home with a catheter. Acute postoperative pain in the postanesthesia care unit was assessed using a visual analogue scale. Multivariate and univariate analyses were completed.

Seven hundred fifteen patients underwent vaginal native tissue repair surgery for pelvic organ prolapse. Two hundred eighty-one (39%) eligible patients underwent perineoplasty. Patients who had a perineoplasty were more likely to have urinary retention when compared to those without perineoplasty (30.2% vs 19.1%, p < 0.01). There was no statistically significant difference in immediate postoperative pain in patients that underwent perineoplasty.

We found a significant association between perineoplasty and postoperative urinary retention. Surgeons should discuss with their patients the risks and benefits of perineoplasty.