Voiding Dysfunction After Prolapse Surgery: Uterosacral Ligament Suspension Versus Sacrospinous Ligament Suspension

This study compared the rate of postoperative urinary retention between women undergoing apical prolapse repair via uterosacral ligament suspension (USLS) versus sacrospinous ligament fixation (SSLF). We hypothesized that voiding dysfunction may be higher following SSLF.

We conducted a retrospective chart review study in a tertiary academic center from January 2015 through February 2025, including all patients undergoing either SSLF or USLS surgery. Voiding trials were generally performed the same day as the surgery. Specifically, the bladder was backfilled with 300 mL of sterile water or saline, the catheter was removed, and patients had to void ≥ 200 mL within 30 min to be discharged without a catheter. Univariate and multivariable logistic regression analyses were performed with a threshold of statistical significance set at p < 0.05 to examine the association between surgical approach and voiding trial outcome while controlling for relevant clinical and demographic factors.

The study included two patient groups (USLS 577; SSLF 186) who underwent surgery with mean ages of 63 and 67 years, respectively (p < 0.001). Race distribution differed between subgroups, with "White, non-Hispanic" being the most frequent category in both (84.1%; 71%; p = 0.003). Alcohol use (p = 0.015) and baseline pelvic organ prolapse stage also varied between the two surgical cohorts (USLS 50.1% stages I and II; SSLF: 61.8% stages III and IV; p = 0.006). Most patients in both groups experienced preoperative urinary incontinence (72.1%; 60.2%; p = 0.003) and underwent concomitant surgical procedures including mid-urethral slings (p < 0.001). In univariate analysis, there was no difference in voiding trial outcomes between both groups (p = 1). After controlling for confounders, the overall voiding trial outcomes did not differ in a statistically significant manner between the USLS and SSLF groups (OR 2.53, 95% CI 0.23-61.01, p = 0.48). This was also true even when slings were excluded (p = 0.3).

There was no observed difference in postoperative voiding dysfunction between the two surgical approaches. Future studies with larger sample sizes may garner different results.