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Utility of Cystoscopy During Hysterectomy

Sandberg, Evelien M.; Cohen, Sarah L. MD, MPH; Hurwitz, Shelley PhD; Einarsson, Jon I. MD, MPH

doi: http://10.1097/AOG.0b013e318272393b
Original Research

OBJECTIVE: To estimate the incidence of cystoscopy use at time of hysterectomy and its use to detect urinary tract injury.

METHODS: This was a retrospective cohort study in a tertiary care academic center of 1982 patients who underwent a hysterectomy for any indication (excluding obstetric) between January 2009 and December 2010. Medical records were reviewed for baseline and perioperative characteristics, cystoscopy use, and information about bladder or ureteral injury related to hysterectomy.

RESULTS: Two hundred fifty-one women (12.66%, 95% confidence interval [CI] 11.23–14.21%) underwent a cystoscopy at the time of hysterectomy with no reported complications resulting from the cystoscopy procedure. Cystoscopy was most frequently used by low-volume surgeons and in cases involving prolapse or vaginal mode of access. Fourteen patients (0.71%, 95% CI 0.39–1.19%) experienced bladder injury and five patients (0.25%, 95% CI 0.08–0.58%) sustained ureteral injury. None of these complications were detected by cystoscopy; cystoscopy was either normal at the time of hysterectomy or was omitted. The presence of adhesions was significantly associated with bladder injury at the time of hysterectomy (P=.006). Low-volume surgeon and laparoscopic or robotic mode of access were both significantly associated with ureteral injury (P=.023 and P=.042, respectively).

CONCLUSIONS: Our data support selective rather than universal cystoscopy at the time of hysterectomy.

LEVEL OF EVIDENCE: II

Selective (rather than universal) cystoscopy at the time of hysterectomy appears to be an acceptable practice, as demonstrated by analysis of hysterectomy-related urinary tract complications.

Division of Minimally Invasive Gynecologic Surgery and the Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Corresponding author: Jon I. Einarsson, MD, MPH, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, ASB 1-3, Boston, MA 02115; e-mail: jeinarsson@partners.org.

Financial Disclosure Dr. Einarsson is a consultant for Ethicon Endo-Surgery. The other authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.