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Previous cesarean section and risk of urinary tract injury during laparoscopic hysterectomy: a meta-analysis

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Abstract

Introduction and hypothesis

Today laparoscopic hysterectomy (LH) can be performed safely and effectively, even for women with a previous history of cesarean section (CS). However, it is unclear whether the risk of urinary tract injury increases with previous CS during LH.

Methods

PubMed and Embase databases were searched for all studies on previous history of CS and risk of urinary tract injuries during and after LH. Reference lists of the identified studies, reviews, and other relevant publications were also searched. Urinary tract injuries or related complications were the outcomes of interest. Meta-analysis was conducted using an inverse-variance weighted random-effects model.

Results

A total of 7 studies including 3,191 patients were identified in the meta-analysis. Overall, the pooled relative risk (RR) and the corresponding 95 % confidence interval (CI) of urinary tract injury were 3.48 (1.86–6.50) for previous CS compared with no previous CS. However, only two studies reported sufficient data on ureteral injury, and the combined RR was 1.83 (95 % CI 0.19–17.26). All seven studies reported the outcomes of bladder injury, and the pooled RR was 3.75 (95 % CI 1.96–7.17). Stratified analyses showed a basically consistent result with the overall analysis except for that by 1–2 times of previous CS (RR 2.32, 95 % CI 0.56–9.56).

Conclusions

Previous CS is significantly associated with development of bladder injury during LH. No significant association was found yet between previous CS and risk of ureteral injury. Given the limited number of studies, more future studies are required to confirm the associations.

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Conflicts of interest

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Author information

Author notes

    Authors and Affiliations

    1. Department of Obstetrics and Gynecology, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, China

      Yinghua Xu & Qiming Wang

    2. Department of Urology, Ningbo Women and Children’s Hospital, No. 339 Liuting Street, Ningbo, Zhejiang, China

      Furan Wang

    Authors
    1. Yinghua Xu
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    2. Qiming Wang
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    3. Furan Wang
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    Corresponding author

    Correspondence to Furan Wang.

    Additional information

    Yinghua Xu and Qiming Wang are joint first authors and contributed equally to this work.

    Appendix

    Appendix

    PubMed

    (laparoscopy OR laparoscopic OR laparoscopical OR laparoscopically OR laparoscope OR endoscopy OR endoscopic OR endoscopical OR endoscopically OR endoscope OR coelioscopy OR coelioscopic OR coelioscope OR celioscopy OR celioscopic OR celioscopical OR celioscopically OR celioscope OR peritoneoscopy OR peritoneoscopic OR peritoneoscopical OR peritoneoscopically OR peritoneoscope OR laparoendoscopy OR laparoendoscopic OR laparoendoscopically OR laparoendoscope OR minilaparoscopy OR minilaparoscopic OR minilaparoscopically OR minilaparoscope OR robot OR robots OR robotic OR robotics) AND (hysterectomy OR hysterectomies) AND ("cesarean section" OR "cesarean sections" OR "cesarean delivery" OR "cesarean deliveries") AND (((urinary OR urologic OR urological OR ureter OR ureteric OR ureteral OR bladder) AND (injury OR injuries OR trauma OR traumas OR damage OR damages OR lesion OR lesions OR complication OR complications)) OR ((vesico OR vesicovaginal OR vesicouterine OR vesicorectal OR vesicoperitoneal OR uretero OR ureterovaginal OR ureterouterine OR ureterorectal OR ureteroperitoneal OR genital OR genito OR genitourinary OR uro OR urogenital) AND (fistula OR fistulas OR fistulae OR fistulaes)) OR cystotomy OR cystotomies)

    Embase

    (laparoscopy OR laparoscopic OR laparoscopical OR laparoscopically OR laparoscope OR endoscopy OR endoscopic OR endoscopical OR endoscopically OR endoscope OR coelioscopy OR coelioscopic OR coelioscope OR celioscopy OR celioscopic OR celioscopical OR celioscopically OR celioscope OR peritoneoscopy OR peritoneoscopic OR peritoneoscopical OR peritoneoscopically OR peritoneoscope OR laparoendoscopy OR laparoendoscopic OR laparoendoscopically OR laparoendoscope OR minilaparoscopy OR minilaparoscopic OR minilaparoscopically OR minilaparoscope OR robot OR robots OR robotic OR robotics) AND (hysterectomy OR hysterectomies) AND (‘cesarean section’ OR ‘cesarean sections’ OR ‘cesarean delivery’ OR ‘cesarean deliveries’) AND (((urinary OR urologic OR urological OR ureter OR ureteric OR ureteral OR bladder) AND (injury OR injuries OR trauma OR traumas OR damage OR damages OR lesion OR lesions OR complication OR complications)) OR ((vesico OR vesicovaginal OR vesicouterine OR vesicorectal OR vesicoperitoneal OR uretero OR ureterovaginal OR ureterouterine OR ureterorectal OR ureteroperitoneal OR genital OR genito OR genitourinary OR uro OR urogenital) AND (fistula OR fistulas OR fistulae OR fistulaes)) OR cystotomy OR cystotomies)

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    Xu, Y., Wang, Q. & Wang, F. Previous cesarean section and risk of urinary tract injury during laparoscopic hysterectomy: a meta-analysis. Int Urogynecol J 26, 1269–1275 (2015). https://doi.org/10.1007/s00192-015-2653-5

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    • DOI: https://doi.org/10.1007/s00192-015-2653-5

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