Perineoplasty, Pain, and Urinary Retention Following Native Tissue Vaginal Prolapse Surgery.

Introduction: Perineoplasty is commonly performed at the time of pelvic reconstructive surgery. Data on the immediate postoperative complications from perineoplasty are sparse.

Objective: Perineoplasty performed at the time of vaginal prolapse surgery increases postoperative urinary retention and pain.

Methods: We conducted a retrospective cohort study on patients undergoing vaginal prolapse surgery with or without perineoplasty from 2014-2023 at an academic institution. Demographics, intra and postoperative characteristics, including pain scores, medical comorbidities, and surgical procedures performed, were compared. Postoperative urinary retention was defined as failing a retrograde voiding trial necessitating discharge home with a catheter. Acute postoperative pain in the postanesthesia care unit was assessed using a visual analogue scale. Multivariate and univariate analyses were completed.

Results: Seven hundred fifteen patients underwent vaginal native tissue repair surgery for pelvic organ prolapse. Two hundred eighty-one (39%) eligible patients underwent perineoplasty. Patients who had a perineoplasty were more likely to have urinary retention when compared to those without perineoplasty (30.2% vs 19.1%, p < 0.01). There was no statistically significant difference in immediate postoperative pain in patients that underwent perineoplasty.

Conclusions: We found a significant association between perineoplasty and postoperative urinary retention. Surgeons should discuss with their patients the risks and benefits of perineoplasty.