Sling Trocar Perforation Rates With and Without Concomitant Prolapse Surgery

Importance Midurethral slings are frequently placed during prolapse surgery. Objectives The objectives of this study were to compare retropubic midurethral sling (MUS) bladder trocar perforation rates among women undergoing MUS-only (soloMUS) surgery versus MUS with concomitant apical prolapse repair (popMUS). Study Design A retrospective cohort study of women aged 18–89 years who underwent MUS surgery between January 2018 and October 2024 was performed. Transobturator sling surgery and nonapical concomitant prolapse repairs were excluded. The primary outcome was bladder trocar perforation rates. Secondary outcomes included emergency department visits, reoperation rates, and admissions within 30 days of the procedure. Results A total of 816 MUS procedures met eligibility criteria, with 236 patients in the popMUS group and 580 in the soloMUS group. Age was lower (52 vs 65, P <0.001) and body mass index (BMI) was higher in the soloMUS group (30 vs 28, P =0.001). The primary outcome, the bladder trocar perforation rate, was higher in the popMUS group (11.0% vs 4.3%, P <0.001). Readmissions and emergency department visits were higher for the popMUS group, but reoperations were similar. When controlling for age, BMI, concomitant hysterectomy, concomitant sacrocolpopexy, surgeon, and menopause status, sacrocolpopexy and surgeon remained significant. Women undergoing sacrocolpopexy were significantly more likely to have bladder perforation compared with those undergoing nonsacrocolpopexy prolapse repairs (OR,2.47; 95% CI, 1.04–5.89, P =0.04). Conclusions Overall, trocar perforations were higher in women undergoing concomitant apical prolapse repair, especially at the time of sacrocolpopexy. This may be due to differential tissue tension in the immediate postprolapse repair anatomy that differs from naturally supported anatomy. Further work is needed to identify perforation risks for concomitant surgical procedures and clinical sequelae.