The value of intraoperative cystoscopy in urogynecologic and reconstructive pelvic surgery.
OBJECTIVE
Our goal was to evaluate the role of intraoperative cystoscopy during surgery for pelvic organ prolapse and urinary incontinence.


METHODS
Charts of 224 consecutive patients who had intraoperative cystoscopy performed after urogynecologic surgery were reviewed.


RESULTS
Nine injuries occurred that were unsuspected before cystoscopy, for an incidence of 4%. Six ureteral ligations occurred, four after Burch cystourethropexy and two after vaginal culdoplasty. 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.
Harris
R L
RL
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Cundiff
G W
GW
Theofrastous
J P
JP
Yoon
H
H
Bump
R C
RC
Addison
W A
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D007432:Intraoperative Period; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014551:Urinary Tract / Q000293:injuries; D014596:Uterine Prolapse / Q000601:surgery*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery