General vs spinal anesthesia in transvaginal hysterectomy with anterior and posterior repair with pelvic organ prolapse patients: Retrospective cohort study

Pelvic organ prolapse (POP) is commonly managed with transvaginal hysterectomy (TVH) and pelvic floor repair. As the population ages, the need for POP surgery continues to increase, typically under either spinal or general anesthesia. Although spinal anesthesia is associated with fewer postoperative complications, concerns regarding postoperative urinary retention (POUR) remain. This study was designed to investigate whether the type of anesthesia influences the incidence of POUR in POP surgery. This retrospective cohort study analyzed 350 patients who underwent TVH with anterior and posterior repair for POP at the Chonnam National University Hospital between January 2018 and June 2023. Patients were divided into spinal anesthesia (n = 167) and general anesthesia (n = 183) groups. Primary outcomes were POUR, catheter reinsertion, length of hospital stay, and urinary symptoms. Multivariable logistic regression was used to identify independent predictors of post-discharge urinary tract infection symptoms. A total of 350 patients were analyzed (spinal anesthesia, n = 167; general anesthesia, n = 183). The baseline characteristics, including age, body mass index, parity, and comorbidities, were comparable between the groups. No significant differences were observed in POP quantification stage or perioperative variables. Postoperatively, catheter reinsertion was required in 9.0% of the spinal group and 2.2% of the general group (P = .182). Urinary symptoms at 1 week occurred in 1.8% and 7.2% of the spinal anesthesia and general anesthesia group, respectively (P = .176). Multivariate logistic regression identified no independent predictors of post-discharge urinary tract infection symptoms. Both anesthesia types demonstrated comparable safety, voiding function, and recovery outcomes after TVH with anterior and posterior repair for POP. POUR rates were comparable between the spinal and general anesthesia groups, supporting their similar safety and recovery profiles, consistent with the principles of enhanced recovery after surgery.