title: The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, University Hospital, New Orleans, USA. vakilibabak@hotmail.com
authors.forename: Babak
authors.initials: B
authors.lastname: Vakili
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Chesson
authors.forename: Brooke L
authors.initials: BL
authors.lastname: Kyle
authors.forename: S Abbas
authors.initials: SA
authors.lastname: Shobeiri
authors.forename: Karolynn T
authors.initials: KT
authors.lastname: Echols
authors.forename: Richard
authors.initials: R
authors.lastname: Gist
authors.forename: Yong T
authors.initials: YT
authors.lastname: Zheng
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Nolan
mesh_terms: 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