Timing of Midurethral Sling Placement During Minimally Invasive Sacrocolpopexy

Surgeons traditionally place the synthetic midurethral sling (MUS) after completing the apical suspension procedure during surgical procedures for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesize it may be more efficient to perform the MUS procedure at the beginning of the case without compromising MUS treatment success.

The objective of this study was to determine whether MUS timing affects SUI treatment outcomes 3 months after surgery.

A retrospective cohort study was performed of patients who had minimally invasive sacrocolpopexy (SCP) at a single tertiary care center between June 2023 and June 2024. As routine practice, 4 surgeons place MUS before and 4 place MUS after completion of the SCP. Surgical cases were categorized into "MUS pre-SCP" and "MUS post-SCP". SUI treatment failure was defined as (1) patient report of persistent or de novo SUI, (2) positive cough stress test result, and/or (3) retreatment for SUI (including pelvic floor physical therapy, pessary, or surgery).

Sixty-six participants had MUS placed before the SCP (MUS pre-SCP), and 111 had MUS placed after completing the SCP (MUS post-SCP). The MUS pre-SCP group was more likely to have advanced stage 3/4 POP ( P < 0.001). The MUS pre-SCP group was more likely to have had a concomitant hysterectomy ( P = 0.01), total hysterectomy ( P < 0.001), single-port robotic procedure ( P <0.001), and shorter operative times ( P < 0.001). Overall, SUI treatment failure was similar between MUS pre-SCP and post-SCP cohorts ( P = 0.54).

Placing an MUS before minimally invasive SCP did not affect SUI treatment outcomes at 3 months and was associated with shorter operative time.