title: Expectant management of cystotomy at the time of midurethral sling placement: a retrospective case series.
abstract: OBJECTIVE
  Cystotomy is one of the most common complications of retropubic midurethral sling placement. Some centers manage cystotomy with prolonged catheter drainage, and there are few published studies evaluating this practice. The purpose of this study is to review postoperative outcomes of patients who experienced cystotomy at the time of sling placement and did not undergo prolonged catheter drainage.
  
  
  METHODS
  This is a retrospective review of all patients undergoing midurethral sling placement complicated by a cystotomy at the University of Rochester between 2004 and 2009. Outpatient and inpatient records were reviewed and data collected include demographics, intraoperative details, voiding trial results, postoperative complications, and voiding function. Descriptive statistics were performed.
  
  
  RESULTS
  Between 2004 and 2009, 30 subjects experienced a cystotomy of the 374 subjects that had a midurethral sling placed, all by a suprapubic approach. There were 25 patients who underwent a voiding trial on the day of surgery and 20 (80 %) were discharged home without prolonged drainage. Five subjects (20 %) had urinary retention and were discharged with an indwelling catheter. All five successfully voided within 4 days of discharge. No subject required subsequent catheterization for any reason and at the 6-week postoperative evaluation all subjects denied voiding dysfunction or irritative bladder symptoms. No subject required additional intervention and postoperative complications were rare.
  
  
  CONCLUSIONS
  In this study, the majority of subjects experiencing a cystotomy during midurethral sling placement were successfully discharged home the day of surgery without catheter drainage. The results suggest that prolonged catheter drainage after a cystotomy during midurethral sling placement may be unnecessary.
authors: Department of Obstetrics and Gynecology, University of Michigan, L4000 Women's Hospital, Ann Arbor, MI 48109-5276, USA. ecrosby@med.umich.edu
authors: Erin C
authors: EC
authors: Crosby
authors: Smitha
authors: S
authors: Vilasagar
authors: Erin E
authors: EE
authors: Duecy
authors: Michael K
authors: MK
authors: Flynn
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D019468:Disease Management; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D053825:Suburethral Slings; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D014554:Urination / Q000502:physiology