The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy.
OBJECTIVE
To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease.


METHODS
Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy.


RESULTS
Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy.


CONCLUSIONS
The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered.
Vakili
Babak
B
Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, University Hospital, New Orleans, USA. vakilibabak@hotmail.com
Chesson
Ralph R
RR
Kyle
Brooke L
BL
Shobeiri
S Abbas
SA
Echols
Karolynn T
KT
Gist
Richard
R
Zheng
Yong T
YT
Nolan
Thomas E
TE
D000328:Adult; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D014513:Ureter / Q000293:injuries* / Q000473:pathology*; D001743:Urinary Bladder / Q000293:injuries* / Q000473:pathology*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000473:pathology