Comparing Postoperative Urinary Retention Rates Between Robotic Apical Prolapse Repairs.

IMPORTANCE: Understanding the risk of urinary retention with different prolapse repair surgical procedures is important for perioperative counseling. OBJECTIVE: The study compared postoperative urinary retention rates between robotic sacrocolpopexy and robotic uterosacral ligament suspension. STUDY DESIGN: This institutional review board-exempt retrospective cohort study compared patients who underwent pelvic organ prolapse repair with robotic sacrocolpopexy (RSCP) and robotic uterosacral ligament suspension (RUSLS) between June 2018 and March 2022. Our primary outcome was the rate of acute postoperative urinary retention (POUR) in these groups. Secondary outcomes were the number of days needed to resolve urinary retention and persistent voiding dysfunction. RESULTS: Out of 298 patients, 258 underwent RSCP and 40 underwent RUSLS. Acute POUR was found in 73 patients (24%): 46 patients (18%) in the RSCP group versus 26 patients (65%) in the RUSLS group (P < 0.001). Multivariate analysis demonstrated a significantly higher rate of acute POUR after RUSLS (odds ratio [OR] = 17.92, confidence interval [CI] = 3.06-104.86; P = 0.001). Patients with an elevated preoperative postvoid residual volume >100 mL or concomitant midurethral sling were more likely to develop POUR (OR = 2.93, CI = 1.43-5.98; P = 0.003 and OR = 2.19, CI = 1.16-4.14; P = 0.016, respectively). While patients with higher parity were less likely to have urinary retention (OR = 0.71, CI = 0.53-0.96; P = 0.024), age, body mass index, prolapse stage, and concurrent posterior repair did not affect the urinary retention rate significantly. The number of days needed to resolve POUR and persistent voiding dysfunction were similar. CONCLUSIONS: Acute POUR appears more likely to develop after RUSLS compared to RSCP. Elevated preoperative postvoid residual volume and concomitant midurethral sling surgery independently increase the risk of POUR.

Pudendal Nerve Block With Liposomal Bupivacaine for Sacrospinous Ligament Suspension.

IMPORTANCE: Pudendal nerve block has been frequently used as a pain management modality for vaginal prolapse surgery. However, studies investigating its efficacy and the type of anesthetic used have had conflicting results. OBJECTIVE: This study aimed to evaluate the effect of intraoperative pudendal nerve block with liposomal bupivacaine on postoperative pain after sacrospinous ligament suspension surgery. STUDY DESIGN: In this single-blinded randomized controlled trial, 83 women undergoing sacrospinous ligament suspension were randomized to receive either intraoperative pudendal nerve block with liposomal bupivacaine or no block. Participants recorded their pain level on postoperative days (PODs) 1-3 and 7, the number of pain medication pills consumed, and the quality of their recovery using a validated questionnaire. RESULTS: There were no significant differences in pain scores between the groups on POD 1 and POD 3: 5 (2-6.25) versus 5.5 (4-8; P = 0.058) and 4 (1-6) versus 5 (2-7; P = 0.146), respectively. On POD 2, the overall pain score was statistically different between the groups, with the block group having lower interquartile ranges. This difference, however, was not clinically significant: 5 (1.75-5) versus 5 (3.25-7.75; P = 0.023). In the subset of participants who underwent a concomitant midurethral sling procedure, POD 2 and POD3 pain scores were significantly lower in those who received the block: 3 (1-5) versus 6 (5-8; P = 0.006) for POD 2 and 3 (1-5) versus 5 (3.250-7; P = 0.042) for POD 3. There were no significant differences in pain medication consumption or the quality of recovery scores. CONCLUSION: Pudendal nerve block with liposomal bupivacaine did not result in significant differences in postoperative pain after sacrospinous ligament suspension, except in those participants who underwent a concomitant midurethral sling procedure.

A urinary catheter valve is non-inferior to continuous bladder drainage with respect to post-operative UTIs: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Urinary tract infections (UTIs) are common with indwelling catheter use. Our primary aim was to compare UTI rates in women sent home after surgery with continuous bladder drainage versus a urinary catheter valve. METHODS: This was a non-inferiority prospective randomized controlled study between June 2016 to June 2019. Women who were being discharged home with a Foley catheter following urogynecologic surgery due to urinary retention were randomized to a continuous urinary drainage bag or a urinary catheter valve. The primary outcome of this study was post-operative UTI rates within 30 days of surgery. The secondary outcome was patient satisfaction, as determined by a Foley satisfaction questionnaire. RESULTS: Out of 97 women, 51 were randomized to continuous drainage and 46 to the urinary catheter valve. Comparing UTI rates, the urinary catheter valve (32.6%) was non-inferior to the continuous urinary drainage bag (33.3%). The upper bound of the 95% CI was less than the predetermined non-inferiority margin (difference 0.7%, 95% CI: -0.195, 0.180), and therefore non-inferiority criteria were met. Patients were more satisfied with the urinary catheter valve than with the continuous drainage bag (p ≤ 0.001). CONCLUSIONS: Use of this urinary catheter valve increased patient satisfaction without affecting the post-operative UTI rate. This easy and inexpensive device could help patients have a better catheter experience and should be considered in women being discharged home with a urinary catheter.

Putting POP-Q to the test: does C - D = cervical length?

INTRODUCTION AND HYPOTHESIS: We investigated the correlation between calculated cervical length (CCL) and gross specimen cervical length (GCL) after total vaginal hysterectomy (TVH) at the time of surgery for pelvic organ prolapse (POP). METHODS: This was a retrospective chart review of patients who had undergone TVH with reconstructive surgery for POP between 2013 and 2015. Patients without an intact specimen or documented cervical length in the pathology report were excluded. CCL was defined as the absolute difference between Pelvic Organ Prolapse Quantification (POP-Q) points C and D. GCL was obtained from the pathology report as the distance from the external to the internal os. The Bland-Altman method was used to assess the accuracy of POP-Q measurements with a priori ranges. Symptom severity was evaluated using the PFDI-20 questionnaire. Analysis of variance was used to model both GCL and CCL as a function of prolapse stage and the leading compartment. RESULTS: The final analysis included 202 subjects. Of the CCL measurements, 56.93% were within ±2 cm of GCL, while 36.14% were within ±1 cm. POP stage was significantly associated with GCL (P < 0.0024). CCL was significantly longer in patients with stage 4 POP (3.57 cm, 95% CI 3.13-4.00) than in those with stage 2 POP (P < 0.0017; mean 2.68 cm, 95% CI 2.45-2.92) and stage 3 POP (P < 0.0300; mean 2.94 cm, 95% CI 2.73-3.15). There were no significant correlations between PFDI scores and CCL or GCL. CONCLUSIONS: The agreement between POP-Q CCL (|C - D|) and GCL decreases with increasing POP-Q stage. There was no correlation between POP symptom severity and GCL or CCL. GCL significantly increased with increasing POP stage.