OBJECTIVE: To report the frequency of abnormal cystoscopy at incontinence surgery and identify risk factors and sequelae of injury.
STUDY DESIGN: Findings of cystoscopy were prospectively collected in 3 multicenter surgical trials. Clinical, demographic, procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and non-injury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months post-procedure were assessed.
RESULTS: Abnormal findings in the bladder or urethra were identified in 95 of 1,830 (5.2%) women. Most injuries were iatrogenic (75.8%). Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral slings (MUS) (6.4% each), followed by autologous pubovaginal slings (PVS) (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 v. 51.9 years; p=0.04), vaginal deliveries (3.2 vs. 2.6, p=0.04), and blood loss (393 vs. 218 ml, p=0.01) were associated with LUT injury during retropubic urethropexy, but only age (62.9 vs 51.4 yrs, p=0.02) and smoking history (p=0.04) were associated for PVS. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, prior incontinence surgery, concomitant procedures, anesthesia type and trainee participation did not increase LUT injury frequency. Though discharge with an indwelling catheter was more common after trocar perforation compared to the non-injury group (55.6% vs. 18.5%, p < 0.001), they did not differ in overall success, voiding dysfunction, recurrent UTIs or urge urinary incontinence.
CONCLUSION: Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations addressed intraoperatively have no long-term adverse sequelae.
Written by:
Zyczynski HM1, Sirls LT2, Greer WJ3, Rahn DD4, Casiano E5, Norton P6, Kim HY7, Brubaker L8 Are you the author?
1Division of Urogynecology and Pelvic Reconstructive Surgery, Mage-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: . 2Department of Urology, William Beaumont Hospital, Royal Oak, MI. 3Division of Urogynecology & Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL. 4Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX. 5Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, TX. 6Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. 7New England Research Institutes, Watertown, MA. 8Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Chicago, IL.
Reference: Am J Obstet Gynecol. 2013 Dec 28 (Epub ahead of print)
doi: 10.1016/j.ajog.2013.12.040
PubMed Abstract
PMID: 24380742
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