title: Universal Cystoscopy After Benign Hysterectomy: Examining the Effects of an Institutional Policy.
abstract: OBJECTIVE
  To evaluate the association between a universal cystoscopy policy at the time of benign hysterectomy and the detection of urologic injuries.
  
  
  METHODS
  This is a retrospective cohort study at a tertiary care academic center where a policy of universal cystoscopy at the time of benign hysterectomy was instituted on October 1, 2008. Benign hysterectomies performed from March 3, 2006, to September 25, 2013, were included and dichotomized into preuniversal and postuniversal cystoscopy groups. Medical records were reviewed for baseline and perioperative characteristics, cystoscopy use, and urologic injuries related to hysterectomy. Urologic injuries were identified by using a search engine and a departmental quality improvement database.
  
  
  RESULTS
  Two thousand nine hundred eighteen hysterectomies were identified during the study time period, 96 of which were excluded for indications of abdominopelvic cancers and peripartum indications. Therefore, 973 women were in the preuniversal cystoscopy group and 1,849 were in the postuniversal cystoscopy group. Thirty-six percent (347/973, 95% confidence interval [CI] 32.8-38.8%) and 86.1% (1,592/1,849, 95% CI 84.5-87.7%) of patients underwent cystoscopy prepolicy and postpolicy, respectively. The urologic injury rates were 2.6% (25/973, 95% CI 1.6-3.6%) and 1.8% (34/1,849, 95% CI 1.2-2.5%) in the prepolicy and postpolicy groups, respectively. Delayed urologic injuries decreased significantly (0.7% [7/973], 95% CI 0.3-1.2% compared with 0.1% [2/1,849], 95% CI 0.0-0.3%). Of the nine patients with delayed injuries, four had normal intraoperative cystoscopy findings and five had no cystoscopy performed.
  
  
  CONCLUSIONS
  The practice of universal cystoscopy at the time of hysterectomy for benign indications is associated with decreased delayed postoperative urologic complications.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Chi
authors.forename: Diana S
authors.initials: DS
authors.lastname: Curran
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Morgan
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
authors.forename: Carolyn W
authors.initials: CW
authors.lastname: Swenson
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D003558:Cystoscopy / Q000592:standards* / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D016134:Organizational Policy; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery*