title: The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse.
abstract: OBJECTIVE
  The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy.
  
  
  METHODS
  The study was a retrospective review of 700 consecutive patients who underwent vaginal surgery for anterior and/or apical pelvic organ prolapse with universal intraoperative cystoscopy.
  
  
  RESULTS
  Thirty-seven patients (5.3%) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3%, respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1%. Intraoperative cystoscopy was accurate in 99.3% of cases, with a sensitivity and specificity of 94.4% and 99.5%, respectively. Suture removal relieved ureteral obstruction in 88% of cases. Six subjects (0.9%) had true ureteral injuries.
  
  
  CONCLUSIONS
  Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1%. Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. ashbym@ccf.org
authors.forename: A Marcus
authors.initials: AM
authors.lastname: Gustilo-Ashby
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.forename: Eun-Hee
authors.initials: EH
authors.lastname: Yoo
authors.forename: Marie Fidela R
authors.initials: MF
authors.lastname: Paraiso
authors.forename: Mark D
authors.initials: MD
authors.lastname: Walters
mesh_terms: D000368:Aged; D004396:Coloring Agents; D003558:Cystoscopy / Q000592:standards; D005188:False Negative Reactions; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007203:Indigo Carmine; D007431:Intraoperative Complications / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014513:Ureter / Q000293:injuries; D014517:Ureteral Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology*; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine