The role of cystourethroscopy in patients with previous pelvic surgery

Abstract

Objectives: 1) To determine the frequency of lower urinary tract injury (LUTI) in patients with previous pelvic surgery and 2) to evaluate the role of routine cystourethroscopy (CUS) in these patients. Materials and Methods: The records of all women who had previous pelvic surgery without a documented intraoperative cystoscopy who later underwent postoperative office CUS at Montefiore Medical Center between January 1999 and May 2000 were retrospectively reviewed. All patients underwent a detailed urogynecologic history and physical examination, urine analysis, and urine culture. All patients then underwent routine office CUS. Results: Sixty-seven patients met the inclusion criteria. All but one had their primary surgery at other institutions. The mean age was 64 (range, 54–77). Previous surgical procedures included 35 abdominal hysterectomies, 5 vaginal hysterectomies, 1 hysteropexy, 9 suburethral slings, 10 anterior colporrhaphies, 2 retropubic suspensions, and 15 bladder repairs. The cystourethroscopic diagnoses were as follows: 54 with atrophic urethritis, 14 with interstitial cystitis, and 2 with intravesical sutures. The rate of LUTI was 3% (95% CI 0.2,7). Conclusions: The rate of LUTI is low. The use of CUS is essential to appropriate diagnosis and treatment for patients with lower urinary tract injury consequent to pelvic surgery. We suggest routine intraoperative CUS for patients undergoing pelvic surgery. Prospective studies are warranted.