Risk factors for urologic injury in women undergoing hysterectomy for benign indication

Abstract

<h3>Objectives</h3> Urinary tract injuries are severe complications of hysterectomy. Our objective is to determine the risk factors associated with urologic injury in women undergoing hysterectomy for benign indication. <h3>Methods</h3> A retrospective cohort study (2011–2017) was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Women without urologic injury were compared to women with injury, and multivariate logistic regression models were constructed to control for patient demographics and intra-operative variables. <h3>Results</h3> Among 213,980 women who underwent hysterectomy for benign indication, the rate of urologic injury rate was low (0.6%). The majority of injuries involved the bladder (86.2%); 13.8% involved the ureters. Younger age, lower BMI and abdominal hysterectomy were associated with increased injury. Patients who underwent total hysterectomy had increased odds of urologic injury compared to subtotal (adjusted OR 1.54, 95% CI 1.23–1.93). Patients with Class III obesity had decreased odds of injury compared with patients of normal weight (AOR 0.70, 95% CI 0.55–0.89). An interaction was observed between surgical approach and indication for hysterectomy. Abdominal compared to laparoscopic approach was associated with urologic injury for women with endometriosis (AOR 3.67, 95% CI 2.35–5.72), pelvic pain (AOR 4.36, 95% CI 2.06–9.26), menstrual disorders (AOR 5.71, 95% CI 2.15–15.2), and fibroids (AOR 2.17, 95% CI 1.59–2.96). Vaginal compared to laparoscopic approach was associated with increased odds of injury for women with endometriosis (AOR 2.25, 95% CI 1.16–4.40), menstrual disorders (AOR 14.4, 95% CI 2.28–91.6), and pain (AOR 54.99, 95% CI 1.24–20.1). Iatrogenic urologic injury was associated with increased healthcare utilization. <h3>Conclusions</h3> While the risk of urologic injury during hysterectomy for benign indication is low, the risk is dependent on certain patient disease factors and surgical approach.