title: Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery.
abstract: Our objective was to review our experience and attempt to identify risk factors for ureteral injury during gynecologic surgery for benign conditions. A retrospective chart review was performed of all cases of ureteral injury during gynecologic surgery for benign conditions, at Temple University Hospital, from January 1992 to September 2002. We analyzed hospital records to determine whether the injury was diagnosed intraoperatively, with postprocedure cystoscopy, or if cystoscopy was ineffective in diagnosing the injury. There were nine ureteral injuries during the study period. Of these, two were diagnosed during the procedure, two were discovered by immediate postprocedure cystoscopy, and the other five were discovered during the postoperative period. Of these five, three patients had immediate postprocedure cystoscopy and the injuries were not detected. Risk factors associated with ureteral injury included: a large uterus (5), high-grade cystocele (3), ectopic insertion of the ureter into the bladder (1), and previous surgeries (4). Our conclusion was that negative cystoscopy cannot be solely relied on to rule out ureteral injury, as cases with partial obstruction and ureteral patency can be missed.
authors.affiliation: Depertment of Obstetrics and Gynecology, Division of Urogynecology, Temple University Hospital, 3401 N Broad Street, Seventh floor, Outpatient Building, PA 19140, Philadelphia, USA. dandolv@tuhs.temple.edu
authors.forename: Vani
authors.initials: V
authors.lastname: Dandolu
authors.forename: Elcy
authors.initials: E
authors.lastname: Mathai
authors.forename: Ashwin
authors.initials: A
authors.lastname: Chatwani
authors.forename: Ozgur
authors.initials: O
authors.lastname: Harmanli
authors.forename: Michael
authors.initials: M
authors.lastname: Pontari
authors.forename: Enrique
authors.initials: E
authors.lastname: Hernandez
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007431:Intraoperative Complications / Q000175:diagnosis*; D008875:Middle Aged; D010052:Ovariectomy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000002:abnormalities / Q000293:injuries*; D001743:Urinary Bladder / Q000002:abnormalities