Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery.

Abstract

The authors, Dandolu et al. [1], and the editor (see ‘‘Editorial Comment’’ to [1]) conclude that in instances of partial ureteral obstruction cystoscopy is inadequate for detection. This leaves the patient in the lurch. This clinical situation is one of many where patients could benefit from better cross-training between gynecology and urology. During cystoscopy, retrograde pyelography would be definitive. In patients at risk for ureteral injury, pelvic surgery could be performed on a table suitable for the use of a C-arm. It would be a simple matter to perform retrograde pyelography at the time of cystoscopy. If the study reveals kinking, partial or total obstruction and if the obstruction is due to absorbable sutures, the patient may merely require the insertion of an indwelling ureteral stent. The advent of TVT has brought about significant communication between gynecology and urology. Unfortunately, the development of a combined fellowship between the two specialties seems to be floundering. There are many clinical situations where cross-training and better communication between the specialties would benefit patient care. This article could serve as a stimulus for the beginning of regular combined section meetings between the specialties at both academic centers and community hospitals.