The Role of Office Cystourethroscopy as a Diagnostic Approach for Patients With Irritative Voiding Symptoms After Pelvic Surgery

Abstract

In Brief Objective: The aim of this study was to evaluate the role of cystourethroscopy (CUS) in patients with irritative voiding symptoms after pelvic surgery. Methods: The records of all women with urinary complaints who underwent urogynecologic evaluation and office CUS at our institution during an 18-month period were retrospectively reviewed. Results: Two hundred sixty-eight women underwent office CUS for urinary complaints. Sixty-seven (25%) patients had irritative voiding symptoms after pelvic surgery. The mean age was 64 ± 12 years. Previous surgical procedures included 35 (52%) abdominal hysterectomies, 5 (8%) vaginal hysterectomies, 1 (2%) hysteropexy, 9 (13%) suburethral slings, 10 (15%) anterior colporrhaphies, 2 (3%) retropubic suspensions, and 15 (22%) “unspecified incontinence procedures.” CUS diagnosed 49 (73%) patients with atrophic urethritis, 9 (13%) patients with interstitial cystitis, 5 (8%) patients with both findings of atrophic urethritis and interstitial cystitis, and 2 (3%) patients with intravesical sutures. Both of the patients with sutures had undergone previous reconstructive pelvic surgery. The rate of lower urinary tract injury (LUTI) was 3% (95% confidence interval, 0.2–7). Conclusions: In women with irritative voiding symptoms after pelvic surgery, the rate of undetected LUTI is low, whereas the rate of interstitial cystitis is high. In patients with a history of reconstructive surgery and irritative voiding symptoms, the use of CUS may be warranted. In women with irritative voiding symptoms after pelvic surgery, the presence of intravesical sutures is low, whereas the rate of interstitial cystitis is high.