Cystoscopy after total or subtotal laparoscopic hysterectomy: the value of a routine procedure (original) (raw)
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The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy
The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral injury during total laparoscopic hysterectomy with vault suspension and to document the incidence of this complication in a large series. The charts of 118 patients who underwent laparoscopic hysterectomy with vault suspension from January 1992 to January 1998 were retrospectively reviewed. The patients underwent intra-operative cystoscopic evaluation to verify ureteral permeability and bladder integrity. Intra-operative ureteral obstruction occurred in four patients (3.4%). All complications were immediately fixed and there were no postoperative ureteral problems. No late ureteral complications were observed. Intra-operative cystoscopy allows for early recognition and treatment of obstructive ureteral injuries and may reduce the rate of late postoperative complications during advanced laparoscopic procedures.
American Journal of Obstetrics and Gynecology, 2005
Objective: To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease. Study design: Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy. Results: Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy. Conclusion: The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered. Ó 2005 Elsevier Inc. All rights reserved.
Universal Cystoscopy After Benign Hysterectomy
Obstetrics & Gynecology, 2016
Objective-To evaluate the association between a universal cystoscopy policy at the time of benign hysterectomy and the detection of urologic injuries. Methods-This is a retrospective cohort study at a tertiary care academic center where a policy of universal cystoscopy at the time of benign hysterectomy was instituted on October 1, 2008. Benign hysterectomies performed from March 3, 2006-September 25, 2013 were included and dichotomized into preuniversal and postuniversal cystoscopy groups. Medical records were reviewed for baseline and perioperative characteristics, cystoscopy use, and urologic injuries related to hysterectomy. Urologic injuries were identified by using a search engine and a departmental quality improvement database. Results-Two thousand nine hundred eighteen hysterectomies were identified during the study time period, 96 of which were excluded for indications of abdomino-pelvic cancers and peripartum indications. Therefore, 973 women were in the preuniversal cystoscopy group and 1,849 were in the postuniversal cystoscopy group. Thirty-six percent (347/973, 95% CI 32.8-38.8%) and 86.1% (1,592/1,849, 95% CI 84.5-87.7%) of cases underwent cystoscopy prepolicy and postpolicy, respectively. The urologic injury rates were 2.6% (25/973, 95% CI 1.6-3.6%) and 1.8% (34/1,849, 95% CI 1.2-2.5%) in the prepolicy and postpolicy groups, respectively. Delayed urologic injuries decreased significantly (0.7% [7/973], 95% CI 0.3-1.2% vs. 0.1% [2/1,849], 95% CI 0.0-0.3%). Of the nine delayed injuries, four had normal intraoperative cystoscopy findings and five had no cystoscopy performed. Conclusion-The practice of universal cystoscopy at the time of hysterectomy for benign indications is associated with decreased delayed postoperative urologic complications.
Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: The goal of this study is to find out: how important it is to utilize intraoperative cystoscopy liberally in normal gynaecological procedures to detect urinary tract injuries, how long it takes to do intraoperative cystoscopy and what problems are linked with cystoscopy.Materials: The study is from the year 2016 to 2022 involving around 1221 patients. In a tertiary care facility, retrospective observational research was conducted. The study comprised patients receiving all gynaecological and urogynaecological operations. Malignancy was ruled out. Following gynaecological surgery, a 20-F-30-degree telescope was used to perform a cystourethroscopy. To record case information, a study proforma was created.Results: Intraoperative cystoscopy detected four bladder injuries during anti-incontinence surgery (TVT) and hysterectomy. After a thorough laparoscopic hysterectomy with normal cystoscopy, one patient returned one month later with right ureteric injury. A urinary tract in...
Incidence of lower urinary tract injury at the time of total laparoscopic hysterectomy
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
To determine the incidence of and risk factors for injury to the lower urinary tract during total laparoscopic hysterectomy. All patients who underwent total laparoscopic hysterectomy for benign disease from January 1, 2002 to December 31, 2005, at an academic medical center are included. Subjects undergoing laparoscopic-assisted vaginal hysterectomy, supracervical hysterectomy, or hysterectomy for malignancy were excluded. Intraoperative cystoscopy with intravenous indigo carmine was routinely performed. Relevant data were abstracted to determine the incidence of lower urinary tract injury, predictors of injury, and postoperative complications. Total laparoscopic hysterectomy was performed in 126 consecutive subjects. Two (1.6%) cystotomies were noted and repaired before cystoscopy was performed. Two (1.6%) additional cystotomies were detected during cystoscopy. Absent ureteral spill of indigo carmine was detected in 2 subjects: 1 (0.8%) with previously unknown renal disease and 1 ...
Journal of SAFOMS, 2018
Objective: • To determine the incidence of urinary tract injuries during gynecological surgeries. • To explore the role of universal cystourethroscopy to detect lower urinary tract injuries during gynecological operations to reduce postoperative morbidity and its sequelae. Study design: A prospective observational study. Settings: A tertiary care center. Materials and methods: This was an observational study conducted in 163 women who underwent gynecological surgery at our department during August 2014 to May 2017. Results: Data are classified according to demography, type, and indication of surgery performed in 163 consecutive subjects. History of previous pelvic surgery, if any, was taken into account to correlate with incidence of lower urinary tract injury intraoperatively. The ureteric and bladder injuries detected by routine intraoperative cystourethroscopy were tabulated. Intraoperatively detected rates of silent ureteric and bladder injury by cystourethroscopy are higher than obvious visually inspected injuries. We obtained intraoperatively ureteric injury rate of 0.61% and a bladder injury rate of 4.29% detected by cystourethroscopy. In two patients (1.23%), in spite of bloodstained urine in urobag, we could not detect any lower urinary tract injury. On long-term follow-up, two subjects (1.23%) attended outpatient department with ureterovaginal fistula and one subject (0.61%) developed vesicovaginal fistula. Conclusion: Use of intraoperative universal cystourethroscopy during gynecological operations should be considered routinely to detect unsuspected lower urinary tract injuries and immediate management to prevent its long-term sequelae.
American Journal of Obstetrics and Gynecology, 2003
The purpose of this study was to evaluate the role of cystoscopy during major gynecologic surgery and to describe an interesting and rare complication that was encountered. STUDY DESIGN: This was an observational descriptive study. A retrospective review was performed. Data collected included intraoperative lower urinary tract injuries, injuries that were related directly to cystoscopy, and postoperative morbidity. RESULTS: One hundred one cases were evaluated. Eight lower urinary tract injuries were noted, 4 of which were detected at cystoscopy and 3 of which (2.97%) were detected intraoperatively before cystoscopy. There was one complication that was linked directly to cystoscopy. There were nine postoperative urinary tract infections. Total cost per case excluding anesthesia time was $54.42. CONCLUSION: Liberal use of cystoscopy in gynecologic surgery is recommended. The procedure is safe, easily learned, and inexpensive to perform.
The value of intraoperative cystoscopy in urogynecologic and reconstructive pelvic surgery
American Journal of Obstetrics and Gynecology, 1997
OBJECTIVE: Our goal was to evaluate the role of intraoperative cystoscopy during surgery for pelvic organ prolapse and urinary incontinence. STUDY DESIGN: Charts of 224 consecutive patients who had intraoperative oystoscopy performed after urogynecologic surgery were reviewed. RESULTS: Nine injuries occurred that were unsuspected before cystoscopy, for an incidence of 4%. Six uretera[ ligations occurred, four after Burch cystourethropexy and two after vaginal ouldoplasty. Intravesical sutures were noted after two Burch procedures, and another injury occurred with passage of fascia lata through the bladder during a pubovaginal sling procedure. Eight injuries were managed by removal and replacement of the suture or sling with only one requiring ureteroneocystotomy. When patients with injuries were compared with those without, there were no statistical differences in demographic or surgical parameters. CONCLUSIONS: The potential for damage to the lower urinary tract is significant with complex urogynecologic surgery. Because of the increased and delayed morbidity associated with unrecognized injury, intraoperative surveillance cystoscopy should be considered a part of all such procedures. (Am J
Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy
Obstetrics & Gynecology, 2001
To evaluate the cost-effectiveness of routine cystoscopy at the time of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy in terms of cost per ureteral injury identified and treated. Methods: Using a hospital-based perspective, a decisionanalysis model was constructed to estimate the outcomes and costs of cystoscopy or no cystoscopy at the time of abdominal hysterectomy. A similar model was constructed for vaginal and laparoscopically assisted vaginal hysterectomy to account for the cost of conversion to laparotomy. Cost estimates were based on estimated costs of Duke University Medical Center and from average Medicare reimbursements for similar Diagnostic Related Groups from the Health Care Financing Administration. The incidence of ureteral injury was obtained from a review of the literature. Sensitivity analyses were performed for the following variables: ureteral injury rate, silent ureteral injury rate, cost of cystoscopy, and cost of therapeutic interventions. We assumed a silent renal death rate of 0%. Results: Routine cystoscopy at abdominal hysterectomy was cost-saving above a threshold ureteral injury rate of 1.5%. At a ureteral injury rate of 0.2%, the marginal increase in the cost of routine intraoperative cystoscopy was 108perabdominalhysterectomy,withanassociatedcostof108 per abdominal hysterectomy, with an associated cost of 108perabdominalhysterectomy,withanassociatedcostof54,000 per ureteral injury identified. In comparison, at a ureteral injury rate of 2%, routine cystoscopy gave a marginal cost savings of 44perhysterectomy,withacostsavingsof44 per hysterectomy, with a cost savings of 44perhysterectomy,withacostsavingsof2200 per ureteral injury identified intraoperatively. At the baseline ureteral injury rate of 0.5%, routine cystoscopy had a marginally increased cost of 83perhysterectomy,withanincrementalcost−effectivenessof83 per hysterectomy, with an incremental cost-effectiveness of 83perhysterectomy,withanincrementalcost−effectivenessof16,600 spent per ureteral injury identified. The model constructed for vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy yielded a threshold ureteral injury rate of 2%, above which routine cystoscopy was cost-saving. In both models, the incidence of ureteral injury and the cost of readmission were the two variables with the greatest influence on costeffectiveness. Conclusion: The cost-effectiveness of routine intraoperative cystoscopy depends on the rate of ureteral injury independent of the route of hysterectomy. If that rate exceeds 1.5% for abdominal hysterectomy and 2% for vaginal or laparoscopically assisted vaginal hysterectomy, then routine cystoscopy is cost-effective.