title: Findings of universal cystoscopy at incontinence surgery and their sequelae.
abstract: OBJECTIVE
  The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury.
  
  
  METHODS
  Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed.
  
  
  RESULTS
  Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling (MUS) procedures (6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P = .01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P < .001), they did not differ in overall success, voiding dysfunction, recurrent urinary tract infections, or urge urinary incontinence.
  
  
  CONCLUSIONS
  Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae.
authors.affiliation: Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.affiliation: Department of Urology, William Beaumont Hospital, Royal Oak, MI.
authors.forename: Larry T
authors.initials: LT
authors.lastname: Sirls
authors.affiliation: Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: W Jerod
authors.initials: WJ
authors.lastname: Greer
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School at Dallas, Dallas, TX.
authors.forename: David D
authors.initials: DD
authors.lastname: Rahn
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Casiano
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.affiliation: New England Research Institutes, Watertown, MA.
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL.
authors.forename: Linda
authors.initials: L
authors.lastname: Brubaker
mesh_terms: D000368:Aged; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D007431:Intraoperative Complications / Q000175:diagnosis*; D008875:Middle Aged; D053825:Suburethral Slings / Q000009:adverse effects; D014521:Urethra / Q000293:injuries*; D001743:Urinary Bladder / Q000002:abnormalities* / Q000293:injuries*; D014549:Urinary Incontinence / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery
keywords: cystoscopy; iatrogenic bladder injury; incontinence surgery