Teeluckdharry et al. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy: a systematic review and meta-analysis
Why should you read about this topic?
This is a quote from the paper: “Injuries to the urinary tract, even if they occur relatively infrequently, can cause significant morbidity.”
What were the authors trying to do?
Derive the rates of urinary tract injury during benign gyn surgery and determine whether routine intraoperative cystoscopy reduces the rates of injury detected in the postoperative period
Who participated and in what setting?
Studies (N=79) published between 2004 and 2014
What was the study design?
Systematic review with pooled data
What were the main outcome measures?
Urinary tract injury rate
What were the results?
With routine intraoperative cystoscopy, adjusted ureter injury rates were 0.3% and bladder injury rates were 0.8%. The authors calculated that without routine cystoscopy only 18% of ureter injuries are detected intraoperatively. With routine cystoscopy 95% of injuries are detected. Rates of postoperatively detected injury rates were not different comparing routine with no cystoscopy.
What is the most interesting image in the paper?
What were the study strengths and weaknesses?
Strengths: large number of contemporary studies. Weaknesses: most studies were retrospective, which lowers postoperative injury detection rates
What does the study contribute for your practice?
Until more data are available, a low threshold for intraoperative cystoscopy is probably best.