Utility of Cystoscopy During Hysterectomy

Literature Review Article

Utility of Cystoscopy During HysterectomyEvelien M. Sandberg, Sarah L. Cohen, MD, MPH, Shelley Hurwitz, PhD, and Jon I. Einarsson, MD, MPH. Obstetrics & Gynecology. 2012, December; 120 (6): 1363-70.  

Review
Dr. John Preston Parry, M.D., M.P.H.
 

The authors assessed the utility of cystoscopy in identifying bladder and ureteral injury occurring with hysterectomy. This retrospective cohort study identified 251 women undergoing post-hysterectomy cystoscopy in a two year period (out of a total of 1982 women undergoing hysterectomy at the institution). Nineteen urologic injuries occurred with fourteen cystotomies, five ureteral injuries, however none of these injuries were detected by intraoperative cystoscopy. Ten of the cystotomies were identified and repaired intraoperatively, six of which didn’t use cystoscopy and four of which had cystoscopy confirm adequate repair. The remaining four cystotomies were detected four to ten days later because of postoperative symptoms. Interestingly, two did not have intraoperative cystoscopy while the other two cases had normal intraoperative cystoscopy. All five ureteral injuries did not have intraoperative cystoscopy and were identified in the postoperative period. Adhesions and surgical experience were the primary risk factors for cystotomy and ureteral injury. Given that cystoscopy did not appear to change outcomes or management in any of the 251 cystoscopic procedures, the authors recommend selective rather than universal cystoscopy when performing hysterectomy. 

Comments
Dr. Daniel Williams, M.D.
 

This retrospective study examines the utility of universal intra operative cystoscopy at the time of hysterectomy, regardless of mode of access.   The overall incidence of urinary tract injury was low, although the authors were not able to ensure that all patients with post operative injury were able to be captured.  In this cohort, cystoscopy was not found to be helpful in diagnosing bladder injury intra operatively.   None of the patients who had ureteral injury underwent intra operative cystoscopy.  However, even a post operative cystocopy performed in one of the patients did not diagnose what was later found to be a ureteral injury.  Based on these observations, the usefulness of universal cystoscopy at the time of hysterectomy may not be helpful in changing outcomes regarding injuries to the urinary tract.  Larger, controlled prospective trials are warranted to definitively answer this question.  

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

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