Preoperative Vaginal Microbiota and Risk of Complications After Transobturator Tape Surgery: A Pilot Study

Background: The vaginal microbiota plays a crucial role in maintaining urogenital health, and its disruption may contribute to adverse surgical outcomes. Transobturator tape (TOT) procedures are widely used in the treatment of stress urinary incontinence (SUI), yet factors influencing postoperative complications remain incompletely understood. This study aimed to evaluate the association between preoperative vaginal microbiota and postoperative complications following TOT surgery. Methods: This pilot observational study included 24 women diagnosed with SUI who underwent TOT surgery between February and December 2023. Prior to surgery, all patients received standardized preoperative preparation, including local estrogen therapy and antimicrobial treatment. Vaginal swabs were collected and analyzed using quantitative culture methods to assess microbial composition. Clinical, microbiological, and surgical data were analyzed. Associations between microbiota profiles and postoperative complications were evaluated using univariate and multivariable statistical analyses. Results: Postoperative complications occurred in 5 patients (20.8%). Patients with complications had significantly higher body mass index (BMI) (33.8 ± 5.0 vs. 27.9 ± 5.1 kg/m²; p = 0.028) and a higher prevalence of previous surgeries (80% vs. 42%; p = 0.048). Microbiological analysis revealed that Lactobacillus spp. deficiency was more frequent in patients with complications (60% vs. 21%; p = 0.048), as was the presence of mixed microbial flora indicative of dysbiosis (100% vs. 47%; p = 0.041). Multivariable logistic regression identified BMI (OR = 1.16; p = 0.031), previous surgeries (OR = 3.9; p = 0.049), Lactobacillus spp. deficiency (OR = 4.8; p = 0.038), and mixed flora (OR = 6.2; p = 0.027) as independent factors associated with postoperative complications. Conclusions: Preoperative vaginal microbiota may significantly influence outcomes following TOT surgery. Vaginal dysbiosis, particularly Lactobacillus spp. deficiency and mixed microbial flora, appears to be associated with an increased risk of postoperative complications. These findings suggest that microbiota assessment could be considered in preoperative evaluation. Further large-scale studies using advanced microbiome analysis are warranted to confirm these results.