Toward a Cross-Pathway Susceptibility Profile for Urinary Tract Infection After Pelvic Floor Reconstruction

AIM: Urinary tract infection (UTI) is a frequent early complication after pelvic floor reconstruction. This study examined whether perioperative UTI is associated primarily with the surgical approach or with recurring patient-, disease-, and care-related factors. METHODS: Medical records were retrospectively reviewed for 376 women treated with pelvic floor reconstructive surgery from 2020 through 2025. According to the principal reconstructive procedure, the cohort was divided into three surgical strata: mesh-based sacrospinous fixation accompanied by transobturator tape (TOT) or tension-free vaginal tape (TVT) insertion; combined anterior and posterior colporrhaphy with a midurethral sling; and anterior and posterior colporrhaphy performed without an associated sling procedure. The study endpoint was a symptomatic urinary tract infection confirmed by urine culture during the initial hospital admission. Associations between candidate predictors and infection were estimated separately within each surgical stratum. Stratum-level effect estimates were then integrated using a DerSimonian–Laird random-effects model to obtain pooled odds ratios and 95% confidence intervals. Cross-stratum variability was quantified through Cochran’s Q test and the I2 statistic. RESULTS: Of the 376 women included, 71 experienced a symptomatic, culture-confirmed infection during the perioperative period, producing an overall event rate of 18.9%. The proportion of affected patients varied numerically among the three reconstructive pathways, although no statistically significant difference was observed in the unadjusted comparison. When risk estimates were synthesized across surgical strata, higher odds of infection were observed in postmenopausal women, patients older than 63 years, those with grade III–IV pelvic organ prolapse, women with morbid obesity, patients requiring bladder catheterization for more than 3 days, and those undergoing hysterectomy during the same operation. The principal significant associations showed little or no between-stratum heterogeneity, suggesting a consistent direction of association across surgical approaches, although the limited number of subgroups (k = 3) and instances of non-estimable models restrict definitive conclusions regarding reproducibility; further validation in larger cohorts is warranted. CONCLUSIONS: Perioperative urinary tract infection after pelvic floor reconstructive surgery appears to reflect a multifactorial susceptibility profile, influenced mainly by patient characteristics, prolapse severity, and prolonged catheterization rather than procedure type alone. These findings support individualized risk assessment and reduced unnecessary catheter use. However, differences in baseline characteristics between surgical groups preclude concluding that the procedures carry equivalent infectious risk.