Implementation of a policy of universal cystoscopy at the time of hysterectomy for benign indications: A retrospective comparative study.

Abstract

Lower urinary tract injury (LUTI) is a serious complication of major gynaecologic surgery. Although intra-operative cystoscopy can facilitate timely diagnosis and treatment of LUTI, the optimal approach to cystoscopy at the time of benign hysterectomy remains debatable. To assess whether implementation of a policy of universal cystoscopy at the time of benign hysterectomy was associated with a difference in intra-operative detection and rates of LUTI. Retrospective cohort study at a large regional teaching hospital where a policy of universal cystoscopy at the time of benign hysterectomy was implemented on 30 September 2019. Hysterectomies performed from 1 November 2016 to 31 March 2021 were included and categorised into the 'pre-policy' and 'post-policy' groups. Primary outcomes included the intra-operative detection and overall rates of LUTI. Secondary outcome was the policy adherence rate. Multivariate analysis was used to examine the effect of this policy on the outcomes. There were 584 hysterectomies identified, including 325 in the pre-policy group and 259 in the post-policy group. Cystoscopy was performed in 55.1% in the pre-policy group and 97.7% in the post-policy group (P < 0.01). Adjusted for age, indication and route of hysterectomy, there were no significant differences in the intra-operative cystoscopic detection of LUTI (42.9% vs 25.0%, P=0.55) or the rate of LUTI (2.2% vs 1.5%, P=0.25) after implementation of the policy. The practice of universal cystoscopy at the time of benign hysterectomy has not been associated with a significant change in the intra-operative detection and rates of LUTI at our institution.