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VOLUME 6 , ISSUE 1 ( January-June, 2018 ) > List of Articles

ORIGINAL ARTICLE

Role of Universal Cystourethroscopy to detect Lower Urinary Tract Injuries during Gynecological Surgery

Raveendra P Gondhali

Keywords : Gynecological surgery, Lower urinary tract injury, Universal cystourethroscopy

Citation Information : Gondhali RP. Role of Universal Cystourethroscopy to detect Lower Urinary Tract Injuries during Gynecological Surgery. J South Asian Feder Menopause Soc 2018; 6 (1):26-29.

DOI: 10.5005/jp-journals-10032-1130

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

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 blood-stained 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.


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  1. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, Kauko M, Heikkinen AM, Sjöberg J. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001 Jul;16(7):1473-1478.
  2. Gilmour DT, Baskett TF. Disability and litigation from urinary tract injuries at benign gynecologic surgery in Canada. Obstet Gynecol 2005 Jan;105(1):109-114.
  3. Ferro A, Byck D, Gallup D. Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery. Am J Obstet Gynecol 2003 Aug;189(2):354-357.
  4. Schimpf MO, Gottenger EE, Wagner JR. Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis. BJOG 2008 Aug;115(9):1151-1158.
  5. Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol 2006 Jun;107(6):1366-1372.
  6. Gangia MP, Agrce RE, Spence CR. Surgical injury to ureter. Urology 1976 Jul;8(1):22-27.
  7. Fry DE, Milholen L, Harbrecht PJ. Iatrogenic ureteral injury: options in management. Arch Surg 1983 Apr;118(4): 454-457.
  8. Harkki-Siren P, Sjoberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol 1998 Jul;92(1):113-118.
  9. American College of Obstetricians and Gynecologists. The role of cystourethroscopy in the generalist obstetriciangynecologist practice. ACOG Committee Opinion No. 372. Obstet Gynecol 2007 Jul;110(1):221-224.
  10. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report: practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy. J Minim Invasive Gynecol 2012 Jul-Aug;19(4):407-411.
  11. Cormio L, Ruutu M, Traficante A, Battaglia M, Selvaggi FP. Management of bilateral ureteric injuries after gynaecological and obstetric procedures. Int Urol Nephrol 1993;25(6): 551-555.
  12. Visco AG, Taber KH, Weidner AC, Barber MD, Myers ER. Costeffectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol 2001 May;97(5 Pt 1):685-692.
  13. Teeluckdharry B, Gilmour D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy: a systematic review and meta-analysis. Obstet Gynecol 2015 Dec;126(6):1161-1169.
  14. Mann WJ, Arato M, Patsner B, Stone ML. Ureteral injuries in an obstetrics and gynecology training program: etiology and management. Obstet Gynecol 1988 Jul;72(1):82-85.
  15. Tulikangas PK, Weber AM, Larive AB, Walters MD. Intraoperative cystoscopy in conjunction with anti-incontinence surgery. Obstet Gynecol 2000 Jun;95(6 Pt 1):794-796.
  16. Wiskind AK, Thompson JD. Should cystoscopy be performed at every gynecologic operation to diagnose unsuspected ureteral injury? J Pelvic Surg 1995 Sep;1(3):134-137.
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