Using clinical estimate or catheter measurement of urethral mid-point result in similar retropubic mid-urethral sling position: a randomized trial

• Published in: International Urogynecology Journal 2022-12, Vol.33 (12), p.3555-3561
• Main Authors: Barnes, H. C., Akl, A., Taege, S. K., Brincat, C., Brubaker, L., Mueller, E. R.
• Format: Article
• Language: English
• Subjects: Bladder; Catheters; Female; Gynecology; Humans; Medicine; Medicine & Public Health; Obstetrics; Original Article; Patients; Questionnaires; Reconstructive surgery; Suburethral Slings; Surgical outcomes; Ultrasonic imaging; Urethra - diagnostic imaging; Urethra - surgery; Urinary incontinence; Urinary Incontinence, Stress - diagnostic imaging; Urinary Incontinence, Stress - surgery; Urologic Surgical Procedures; Urology; Vagina
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-022-05167-9

Introduction and hypothesis The objective was to determine whether standardized, intraoperative urethral measurement improves retropubic mid-urethral sling (RPMUS) positioning and if the intraoperative position remains stable at 2 weeks postoperatively. Methods Participants undergoing a RPMUS were randomized to mid-urethral placement as per usual surgical care (no Foley catheter measurement, no-FCM) vs urethral mid-point Foley catheter measurement (FCM). The primary outcomes were RPMUS location as determined by 2D and 3D ultrasound 2 weeks postoperatively (as percentage from urethral meatus − relative to the urethral length) and intraoperatively following the RPMUS placement. Results Forty-four women enrolled, underwent RPMUS, and provided baseline data and intraoperative ultrasound measurements; of these, 36 (82%) had interpretable intraoperative and postoperative ultrasound measurements. Demographic data were similar in the two groups. The mean RPMUS mid-point was 57 % and 55 % in measured and controls ( p = 0.685); this same measurement was relatively unchanged at 2 weeks postoperatively at 57% and 54% respectively ( p = 0.538). Very much and much improvement was reported on the PGI-I by 84% and 85% of participants in the FCM and no-FCM groups respectively. Conclusions Intraoperative RPMUS position at 2 weeks after surgery is similar to the intraoperative position. Compared with usual surgical care, intraoperative measurement of urethral mid-point with a Foley catheter did not affect RPMUS sling position.