Researchers call for routine cystoscopy after hysterectomy

Universal intraoperative cystoscopy following hysterectomy allows immediate repair of injuries to the ureter and bladder that would otherwise go undetected, according to a study published in Obstetrics & Gynecology (2009; 113:6-10).

"Injuries not corrected during the initial hospitalization may result in serious disruption in the patient's quality of life and probable medical-legal action," wrote Thomas E. Nolan, MD, and colleagues at Louisiana State University Health Sciences Center, New Orleans. This "warrants the use of diagnostic cystoscopy after hysterectomy."

The multicenter study involved diagnostic cystourethroscopy performed on 839 patients post-hysterectomy. The incidence of urinary tract injury was 4.3% (39 of 839 cases). The rate of bladder injury was 2.9% (24 of 839 cases), and rate of ureteral injury was 1.8% (15 of 839 cases).

There were three cases of simultaneous bladder and ureteral injuries, resulting in a cumulative injury rate of 4.3%. The injury detection rate using intraoperative diagnostic cystoscopy was 97.4%. The most common site of injury to the ureter was the junction of the ureter and the uterine artery in 80% of ureteral injuries.

Transection and kinking injuries were the most frequent type of injury. There were 21 cases of subnormal dye efflux from the ureteral orifices, with no subsequent injury detected on further evaluation.