title: Utility of cystoscopy during hysterectomy.
abstract: OBJECTIVE
  To estimate the incidence of cystoscopy use at time of hysterectomy and its use to detect urinary tract injury.
  
  
  METHODS
  This was a retrospective cohort study in a tertiary care academic center of 1982 patients who underwent a hysterectomy for any indication (excluding obstetric) between January 2009 and December 2010. Medical records were reviewed for baseline and perioperative characteristics, cystoscopy use, and information about bladder or ureteral injury related to hysterectomy.
  
  
  RESULTS
  Two hundred fifty-one women (12.66%, 95% confidence interval [CI] 11.23-14.21%) underwent a cystoscopy at the time of hysterectomy with no reported complications resulting from the cystoscopy procedure. Cystoscopy was most frequently used by low-volume surgeons and in cases involving prolapse or vaginal mode of access. Fourteen patients (0.71%, 95% CI 0.39-1.19%) experienced bladder injury and five patients (0.25%, 95% CI 0.08-0.58%) sustained ureteral injury. None of these complications were detected by cystoscopy; cystoscopy was either normal at the time of hysterectomy or was omitted. The presence of adhesions was significantly associated with bladder injury at the time of hysterectomy (P=.006). Low-volume surgeon and laparoscopic or robotic mode of access were both significantly associated with ureteral injury (P=.023 and P=.042, respectively).
  
  
  CONCLUSIONS
  Our data support selective rather than universal cystoscopy at the time of hysterectomy.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Evelien M
authors.initials: EM
authors.lastname: Sandberg
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D000267:Tissue Adhesions / Q000209:etiology; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries; D001743:Urinary Bladder / Q000293:injuries; D055815:Young Adult