Urinary implications of retropubic dissection during abdominal wall reconstruction: Early results from a clinical quality assurance initiative

PURPOSE: Abdominal wall reconstruction with transversus abdominus release (TAR) requires space of Retzius dissection for retropubic mesh placement. Retzius space dissection has been associated with postoperative urinary incontinence (UI) in urologic literature, but implications of retropubic dissection are unreported for patients undergoing retromuscular ventral hernia repair. This quality assurance (QA) initiative sought to characterize pre- and postoperative UI prevalence at a high-volume hernia practice to inform risk-benefit discussions and surgical decision-making. METHODS: Patients offered TAR, or who had previously undergone TAR, were given a Urinary Distress Inventory Short-Form (UDI-6) survey as a part of clinical workflow. UI was defined by UDI-6 score ≥33.33, consistent with prior literature. A deidentified QA database captured responses and respondents' age and gender. UI prevalence, UDI-6 total score, and patient characteristics were compared across preoperative, early postoperative, 1-year, and ≥ 2-year cohorts. A matched analysis was conducted for preoperative surveys that could be paired with a postoperative survey from the same patient. The study is reported according to the SQUIRE 2.0 guidelines. RESULTS: Of 304 UDI-6 surveys, 82 (26.9%) met criteria for UI. Respondents were predominantly female (61.5%, n = 187) and median age was 62 years (IQR 53-69); 137 responses were collected preoperatively and 136 were collected in the early postoperative window. UI prevalence was higher at 37% (n = 49) within the preoperative cohort vs 18% with 6 months postoperatively (P = .0007). Thirty-three preoperative surveys were patient-matched to early postoperative surveys; among these, UI prevalence was again higher preoperatively at 30.3% (n = 10) vs 18.2% (n = 6, P = .003). CONCLUSION: Early results from this QA initiative provide reassurance against adverse urinary outcomes following retropubic dissection during TAR. Further prospective clinical trials may help to elucidate if there is a potential benefit to UI from TAR.