Urinary Complications and Injuries Related to Vaginal Mesh Surgery for Pelvic Organ Prolapse: Prevention and Management

Background/Objectives: Pelvic organ prolapse affects up to one in five postmenopausal women. Although transvaginal mesh procedures are restricted to selected cases, they may be followed by transient postoperative urinary retention (POUR) and, rarely, serious urinary tract complications. This study assessed the frequency and risk factors for urinary complications after vaginal mesh prolapse repair and described strategies for their prevention, early detection, and management. Methods: This retrospective, single-center observational study with nested case series included 517 postmenopausal women aged 48–90 years who underwent anterior and apical prolapse repair using the ultralight polypropylene InGYNious anterior system between January 2021 and March 2026. The primary outcome was POUR. Secondary outcomes included urinary tract infection, bladder or ureteral injury, hydronephrosis, oliguria, acute kidney injury, and the need for urological intervention. Results: POUR occurred in 128 of 517 patients (24.8%) within 24 h after catheter removal; 45 of these women (35.2%) required catheterization and retention persisted beyond the first postoperative day in 101 (78.9%). Seven urinary tract injuries were recorded, including four bladder injuries and three cases of ureteral injury or kinking. Four severe postoperative cases were analyzed in detail. Concomitant posterior colporrhaphy was independently associated with POUR (OR = 1.97, 95% CI 1.31–2.97; 31.1% vs. 18.6%) and with any urinary tract complication (OR = 1.52, 95% CI 1.03–2.25). Age, parity, and body mass index were not significantly associated with these outcomes. Conclusions: Careful preoperative evaluation, appropriate surgical training, avoidance of excessive tissue traction, and prompt assessment of postoperative oliguria are essential. Patients should be informed about the possibility of transient urinary retention and the potential need for short-term catheterization.