title: Foley catheter guide use during midurethral slings: does it make a difference?
abstract: BACKGROUND
  Our objective was to evaluate whether foley catheter guide use decreased the risk of cystotomy and urethrotomy during retropubic midurethral sling placement.
  
  
  METHODS
  This retrospective cohort study included all women undergoing retropubic synthetic midurethral sling placement at a single academic institution between January 2011 and September 2012. Patients were divided into groups based on whether or not the foley catheter guide was used during surgery. The primary outcome was the incidence of cystotomy.
  
  
  RESULTS
  A total of 310 patients underwent retropubic midurethral sling placement. The foley catheter guide was used in 76/310 cases (24.5%). The mean age was 57 ± 11 and mean body mass index was 28 ± 7. More patients in the no-guide group had preoperative urgency (70% versus 58%, p = 0.049), anterior prolapse (95% versus 78%, p < 0.0001), and concomitant prolapse surgery (65% versus 51%, p = 0.03). There was no difference in preoperative urgency urinary incontinence, medical comorbidities, previous surgical history, intraoperative time, blood loss, or postoperative voiding dysfunction rates between groups. Fourteen of the 310 patients (4.5%) had cystotomies: 1/76 (1.3%) in the foley catheter guide group and 13/234 (5.6%) in the no-guide group (p = 0.12). No patients had urethrotomies. On multiple logistic regression, there was no difference in the odds of cystotomy between groups after adjusting for previous prolapse and anti-incontinence surgery, concomitant prolapse repair, level of first assistant, and retropubic local anesthesia use (AOR = 0.2 [95% CI 0.02-1.7]).
  
  
  CONCLUSIONS
  Foley catheter guide use did not decrease the risk of intraoperative lower urinary tract injury during retropubic midurethral sling placement. Larger prospective studies are needed to confirm this finding.
authors.affiliation: Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, USA.
authors.forename: Jeannine Marie
authors.initials: JM
authors.lastname: Miranne
authors.forename: Aurora
authors.initials: A
authors.lastname: Dominguez
authors.forename: Andrew Ian
authors.initials: AI
authors.lastname: Sokol
authors.forename: Robert Eric
authors.initials: RE
authors.lastname: Gutman
authors.forename: Cheryl Bernadette
authors.initials: CB
authors.lastname: Iglesia
mesh_terms: D000368:Aged; D053715:Cystotomy; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D053825:Suburethral Slings; D062885:Urinary Catheters; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*