Risk Factors for Intraoperative Bladder Perforation at the Time of Midurethral Sling Placement

• Published in: Urology (Ridgewood, N.J.) N.J.), 2021-02, Vol.148, p.100-105
• Main Authors: Kuhlmann, Paige K., Dallas, Kai, Masterson, John, Patel, Devin N., Chen, Andrew, Castaneda, Peris, Ackerman, A. Lenore, Anger, Jennifer T., Eilber, Karyn S.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Body Mass Index; Cystoscopy; Female; Humans; Intraoperative Complications - diagnostic imaging; Intraoperative Complications - etiology; Logistic Models; Lower Urinary Tract Symptoms - etiology; Middle Aged; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Suburethral Slings - adverse effects; Suburethral Slings - statistics & numerical data; Urinary Bladder - injuries; Urinary Tract Infections - etiology; Wounds, Penetrating - diagnostic imaging; Wounds, Penetrating - etiology; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2020.11.023

To evaluate patient-specific and perioperative factors that may be predictive of bladder perforation during midurethral sling placement. A retrospective chart review of women who underwent a midurethral sling procedure at our institution between 2013 and 2017 was completed. All cases with bladder perforation were included. Patient demographics and perioperative factors were explored for associations with perforation. Bivariate analysis was used to compare baseline characteristics between those with and without perforation. Logistic regression modeling was used to identify predictors of perforation and associations between bladder perforation and postoperative sequelae. Four hundred and ten women had a urethral sling procedure at our institution between 2013 and 2017. Of these, 35 (9%) had evidence of bladder perforation on cystoscopy. This rate was higher for retropubic slings (15%) compared to transobturator slings (2%). Those with a perforation were younger (54 vs 61 years, P= .004) and had a lower average BMI (24.1 kg/m2 vs 26.3 kg/m2, P = .022). Other risk factors included lack of pre-existing apical prolapse (11% vs 4%, P = .012) and concomitant urethrolysis (27% vs 8%, P = .024). In multivariable analysis, age, BMI, and sling type were significantly associated with perforation. In univariate analysis, perforation was associated with postoperative lower urinary tract symptoms (OR 2.3, P = .21) and urinary tract infection within 30 days of surgery (OR 2.2, P = .047). Intraoperative bladder perforation was associated with younger patient age and lower BMI. Additionally, bladder perforation is a risk factor for postoperative urinary tract infection and lower urinary tract symptoms.