Presentation Authors: Carrie Stewart*, Hanson Zhao, Gabriella Gonzales, Christopher Gonzales-Alabastro, A.Lenore Ackerman, Karyn Eilber, Jennifer Anger, Beverly HIlls, CA
Introduction: Due to the risk of unmasking occult stress urinary incontinence, prophylactic midurethral slings are frequently offered at the time of pelvic organ prolapse repair. We present a series of robotic sacrocolpopexy (RS) with prophylactic midurethral synthetic sling (MUS) placement to better understand post-operative outcomes with this combination procedure.
Methods: We performed a retrospective review of 101 consecutive patients who underwent sacrocolpopexy and MUS placement with three FPMRS surgeons at a single institution. We strictly defined a prophylactic sling as one performed when a patient had no history of stress urinary incontinence (SUI) and no SUI on physical examination with prolapse reduction. Forty-three patients had MUS placed for prophylaxis and 58 had placement for SUI by history and/or physical examination. Patient characteristics, pre-operative prolapse exam, and prior prolapse repairs or slings were recorded. Operative details included blood loss, operative times, sling approach (retropubic vs. transobturator), and incidence of trocar perforation. Length of stay, failed trial of void, mesh extrusion, new urgency incontinence and new overactive bladder symptoms, dyspareunia and post-operative UTI rates were recorded. A t-test was used to compare averages in the group and odds ratio was used to compare outcomes.
Results: There was no significant difference in average age, BMI, length of stay, a blood loss, operative times or highest prolapse stage for any compartment. There was no significant difference in rate of de novo urgency, urge incontinence or recurrence of prolapse . Post-operative SUI occurred in 1.7% and 2.3% of those who had slings placed for SUI and prophylaxis respectively. No bladder perforation with the sling trocar was observed. There was a significant difference in the occurrence of one or more post-operative UTI, 9 in the prophylactic group versus 4 in the SUI group (p = 0.04 [CI 1.02-12.5]). Patients who reported post-operative urinary tract infection(s) had at least 1 pre-operative UTI in 2/4 (50%) in the SUI group and 2/9 (22%) in the prophylaxis group.
Conclusions: In this series, we demonstrate a low rate of adverse events when a prophylactic sling was placed at the time of RS.