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Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery

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Abstract

Our objective was to review our experience and attempt to identify risk factors for ureteral injury during gynecologic surgery for benign conditions. A retrospective chart review was performed of all cases of ureteral injury during gynecologic surgery for benign conditions, at Temple University Hospital, from January 1992 to September 2002. We analyzed hospital records to determine whether the injury was diagnosed intraoperatively, with postprocedure cystoscopy, or if cystoscopy was ineffective in diagnosing the injury. There were nine ureteral injuries during the study period. Of these, two were diagnosed during the procedure, two were discovered by immediate postprocedure cystoscopy, and the other five were discovered during the postoperative period. Of these five, three patients had immediate postprocedure cystoscopy and the injuries were not detected. Risk factors associated with ureteral injury included: a large uterus (5), high-grade cystocele (3), ectopic insertion of the ureter into the bladder (1), and previous surgeries (4). Our conclusion was that negative cystoscopy cannot be solely relied on to rule out ureteral injury, as cases with partial obstruction and ureteral patency can be missed.

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Abbreviations

CVA:

Costovertebral angle

IVP:

Intravenous pyelography

UVJ:

Ureterovesical junction

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Authors and Affiliations

  1. Depertment of Obstetrics and Gynecology, Division of Urogynecology, Temple University Hospital, 3401 N Broad Street, Seventh floor, Outpatient Building, Philadelphia, PA 19140, USA

    Vani Dandolu, Elcy Mathai, Ashwin Chatwani, Ozgur Harmanli, Michael Pontari & Enrique Hernandez

Authors
  1. Vani Dandolu
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  2. Elcy Mathai
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  3. Ashwin Chatwani
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  4. Ozgur Harmanli
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  5. Michael Pontari
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  6. Enrique Hernandez
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Corresponding author

Correspondence to Vani Dandolu.

Additional information

Editorial Comment: Ureteral injury during routine benign gynecologic surgery is rare. However, a significant amount of morbidity is associated with delayed diagnosis and with the subsequent therapeutic interventions that occur. It seems intuitive that altered anatomy, whether from previous surgery or from a large myomatous uterus, increases the risk of ureteral injury. Careful and thorough intraoperative ureteral identification combined with routine cystoscopy reduces the incidence of delayed diagnosis of complete ureteral obstruction. For partial ureteral obstruction, though, the role of cystoscopy is less clear. Because ureteral efflux can still occur in partial obstruction, there may be a lot more unrecognized ureteral injuries or ‘kinking’. In spite of these limitations, cystoscopy has little morbidity associated with it, and reduces the delay in diagnosis of other injuries to the lower urinary tract. A high clinical index of suspicion in the immediate postoperative period may be the only way to reduce the subsequent morbidity associated with the delayed diagnosis of partial ureteral obstruction.

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Dandolu, V., Mathai, E., Chatwani, A. et al. Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery. Int Urogynecol J 14, 427–431 (2003). https://doi.org/10.1007/s00192-003-1095-7

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  • DOI: https://doi.org/10.1007/s00192-003-1095-7

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