Timing of Midurethral Sling Placement During Minimally Invasive Sacrocolpopexy

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Pelvic Reconstructive Surgery

Background:

• Midurethral sling (MUS) placement is traditionally performed after apical suspension for pelvic organ prolapse (POP) and stress urinary incontinence (SUI).
• The timing of MUS placement relative to sacrocolpopexy (SCP) has not been extensively studied.
• Hypothesized efficiency gains from performing MUS before SCP without compromising treatment success.

Purpose of the Study:

• To determine if the timing of midurethral sling (MUS) placement affects stress urinary incontinence (SUI) treatment outcomes.
• To evaluate the impact of performing MUS before versus after minimally invasive sacrocolpopexy (SCP) on SUI treatment success at 3 months post-surgery.

Main Methods:

• Retrospective cohort study of patients undergoing minimally invasive sacrocolpopexy (SCP) between June 2023 and June 2024.
• Surgical cases were categorized into "MUS pre-SCP" (n=66) and "MUS post-SCP" (n=111) based on the timing of midurethral sling placement.
• SUI treatment failure was defined by persistent or de novo SUI, positive cough stress test, or retreatment for SUI.

Main Results:

• The "MUS pre-SCP" group had higher rates of advanced stage 3/4 POP, concomitant hysterectomy, and single-port robotic procedures.
• Patients undergoing "MUS pre-SCP" experienced significantly shorter operative times (P < 0.001).
• Overall SUI treatment failure rates were similar between the "MUS pre-SCP" and "MUS post-SCP" groups (P = 0.54).

Conclusions:

• Placing a midurethral sling (MUS) before minimally invasive sacrocolpopexy (SCP) is a safe and effective option for treating stress urinary incontinence (SUI).
• This approach does not compromise SUI treatment outcomes at 3 months.
• Performing MUS before SCP is associated with reduced operative time, suggesting improved surgical efficiency.