title: Risk factors for ureteral occlusion during transvaginal uterosacral ligament suspension.
abstract: OBJECTIVE
  To determine any risk factors associated with ureteral occlusion during transvaginal uterosacral ligament suspension (USLS).
  
  
  METHODS
  A retrospective query to identify patients that underwent transvaginal USLS at a teaching hospital from 2008 to 2013 was performed. Patients in which ureteral occlusion was identified by cystoscopy were identified (cases), and compared with those without occlusion (controls). Medical records were reviewed for data abstraction. Variables compared between cases and controls included demographics, medical history/examination, concomitant procedures, number of suspension sutures placed, estimated blood loss and length of hospital stay. Univariate analyses were performed to identify potential risk factors for ureteral occlusion, followed by multivariate regression analysis to estimate odds ratios for identified predictors.
  
  
  RESULTS
  A total of 144 USLS procedures were performed. Thirteen cases of ureteral occlusion were identified (9%). Baseline prolapse stage, body mass index, parity, previous hysterectomy or pelvic surgery of the groups were similar (all P > 0.05). Univariate analysis identified age (P = 0.04), concomitant anterior colporrhaphy (P = 0.01), and use of a suture-capturing device for suture placement (P = 0.04) as significant factors. On multivariate logistic regression analysis, concomitant anterior colporrhaphy increased ureteral occlusion risk (OR 10.5, 95%CI 2.37-74.99, P = 0.001), while use of a suture-capturing device decreased it (OR 0.1, 95%CI 0-0.41, P = 0.01). The mean number of suspension sutures placed per side was similar in the two groups (2.6 [range 2-4] for cases and 2.4 [range 1-4] for controls, P = 0.15).
  
  
  CONCLUSIONS
  During transvaginal USLS, performance of a concomitant anterior colporrhaphy increased the risk of ureteral occlusion, while the use of a suture-capturing device for suspension suture placement was associated with decreased risk.
authors.affiliation: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
authors.forename: Elisha
authors.initials: E
authors.lastname: Jackson
authors.affiliation: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Bilbao
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Vera
authors.affiliation: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
authors.forename: Zuber D
authors.initials: ZD
authors.lastname: Mulla
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
authors.forename: Veronica T
authors.initials: VT
authors.lastname: Mallett
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX, 79905, USA. teodoro.montoya@ttuhsc.edu.
authors.forename: T Ignacio
authors.initials: TI
authors.lastname: Montoya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D016015:Logistic Models; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology*
keywords: Ureteral injury; Uterosacral ligament suspension; Vaginal prolapse surgery