MP18-11 CYSTOSCOPY AT THE TIME OF HYSTERECTOMY IMPROVES DETECTION OF URETERAL INJURY: A POPULATION BASED ANALYSIS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-11 CYSTOSCOPY AT THE TIME OF HYSTERECTOMY IMPROVES DETECTION OF URETERAL INJURY: A POPULATION BASED ANALYSIS Robert Blackwell, Elizabeth Dray, Matthew Zapf, Anai Kothari, Paul Kuo, Robert Flanigan, and Gopal Gupta Robert BlackwellRobert Blackwell More articles by this author , Elizabeth DrayElizabeth Dray More articles by this author , Matthew ZapfMatthew Zapf More articles by this author , Anai KothariAnai Kothari More articles by this author , Paul KuoPaul Kuo More articles by this author , Robert FlaniganRobert Flanigan More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1043AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hysterectomy is a commonly performed surgical procedure in the United States, with approximately 600,000 surgeries performed annually. Urinary tract injury occurs in 1–2% of all major gynecologic surgeries, most commonly during hysterectomies. We sought to determine how frequently cystoscopy is used at the time of hysterectomy to diagnose potential urinary tract injury, and, if used, whether it can prevent a delay in urinary tract injury diagnosis. METHODS Data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SIP) for Florida was used to identify patients who underwent hysterectomy between 2009–2011. Multi-level clinical classification software expanded procedure categories were used to classify patients as having undergone hysterectomy (124), caesarean section (134), or cystoscopy (100–101). ICD9 codes identified patients with a ureteral injury diagnosis (867.2, 867.3), bladder injury diagnosis (867.1, 867.0), or as having undergone ureteral repair (56.39, 56.79, 56.82, 56.86, 56.89, 56.99, 56.74, 56.75, 56.83) or bladder repair (86.71, 86.70, 57.89, 75.61, 57.85, 57.12, 57.19). Pearson's Chi square test was used to compare treatment and outcome variables. RESULTS Between 2009 – 2011, 70,373 patients underwent hysterectomy in the state of Florida. Cystoscopy was performed concurrently for 9,820 patients (14%). Urinary tract injury was diagnosed over the course of follow-up in 996 patients (1.4%). Bladder Injury diagnosis was made in 730 patients, during either the initial admission in 687 (94%), or over follow-up in 43 (5.9%). The diagnosis of ureteral injury was made in 281 patients, during the initial admission or over follow-up in 176 (63%) and 105 (37%) patients, respectively. In patients who developed a urinary tract injury, there was a decreased rate of delayed ureteral injury when cystoscopy was performed at the time of hysterectomy (17% with cystoscopy, 58% without cystoscopy; χ2=48, p<0.001). There was no difference in the rate of delayed bladder injuries. A limitation of this analysis is the decision-making to perform a cystoscopy. Given the low rate of concurrent cystoscopy, routine screening following hysterectomy was not performed. As such, for patients who underwent cystoscopy there was likely a high clinical suspicion of urinary tract injury. CONCLUSIONS Urinary tract injury is an uncommon complication of hysterectomy. Routine cystoscopic screening following hysterectomy is a quick, minimally invasive, diagnostic procedure that can decrease the rate of delayed diagnosis of ureteral injury. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e209-e210 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Blackwell More articles by this author Elizabeth Dray More articles by this author Matthew Zapf More articles by this author Anai Kothari More articles by this author Paul Kuo More articles by this author Robert Flanigan More articles by this author Gopal Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...