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Sling Trocar Perforation Rates With and Without Concomitant Prolapse Surgery
Alexa Primavera1, Katherine Albus2, Dayun K Lee2
1Women's Institute, West Penn Hospital of Allegheny Health Network, Pittsburgh, PA.
Urogynecology (Philadelphia, Pa.)
|February 2, 2026
Summary
Midurethral sling surgery with concomitant apical prolapse repair had higher bladder trocar perforation rates. Sacrocolpopexy significantly increased perforation risk, suggesting anatomical differences impact outcomes.
Area of Science:
- Urogynecology and Pelvic Reconstructive Surgery
- Surgical Outcomes and Patient Safety
- Female Pelvic Medicine
Background:
- Midurethral slings (MUS) are common in prolapse surgery.
- Understanding risks associated with concomitant procedures is crucial for patient safety.
- Previous data on specific complication rates for combined procedures is limited.
Purpose of the Study:
- To compare retropubic midurethral sling (MUS) bladder trocar perforation rates.
- To evaluate rates between MUS-only (soloMUS) surgery and MUS with apical prolapse repair (popMUS).
- To identify risk factors for bladder perforation in these procedures.
Main Methods:
- Retrospective cohort study of 816 women aged 18-89 undergoing MUS surgery (Jan 2018-Oct 2024).
- Excluded transobturator slings and non-apical repairs.
- Primary outcome: bladder trocar perforation rate; secondary: 30-day ED visits, reoperations, and admissions.
Main Results:
- Bladder perforation rate was higher in the popMUS group (11.0%) vs. soloMUS (4.3%).
- Concomitant sacrocolpopexy significantly increased perforation risk (OR, 2.47; P=0.04).
- PopMUS group had higher readmissions and ED visits; reoperations were similar.
Conclusions:
- Concomitant apical prolapse repair, particularly sacrocolpopexy, is associated with increased trocar perforation risk.
- Differential tissue tension in post-repair anatomy may contribute to higher perforation rates.
- Further research is needed to define risks for combined procedures and their sequelae.
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