Teeluckdharry et al. - Urinary Tract Injury at Benign
Gynecologic Surgery and the Role of Cystoscopy: A Systematic Review and
Meta-analysis.
Obstetrics & Gynecology, December 2015
This is a
recent review and meta-analysis on role of routine use of cystoscopy in benign
gynecological surgeries
Why this
topic is important?
Injuries to the urinary
tract, even if they occur relatively infrequently, can cause significant
morbidity. Thus, intraoperative detection and recognition of urinary
tract injuries remain very important for patients and gynecologists because
they decrease morbidity and result in less litigation. Up to 75% of
ureteric injuries are caused by gynecologic surgery and interestingly, most
injuries occur during procedures for benign diseases.
What is the
aim of the study?
The study aims to
derive the rate of routine urinary tract injuries during benign gynecological
surgeries and does routine use cystoscopy is a safeguard against them.
The subjects
and the study design.
It is a Systematic review
with pooled data from 79 studies between January 2004 to August 2014.
Interesting table in the study:
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| source:http://journals.lww.com/greenjournal/Fulltext/2015/12000/Urinary_Tract_Injury_at_Benign_Gynecologic_Surgery.7.aspx |
Main outcome results:
The study got an adjusted ureteric injury rate of 0.3% and a
bladder injury rate of 0.8%. The estimated postoperative ureteric injury
detection rates per 1,000 surgeries were 1.6 without routine cystoscopy and 0.7
with routine cystoscopy. Postoperative bladder injury detection rates per 1,000
surgeries were 0.8 without routine cystoscopy and 1.0 with routine cystoscopy.
The study found that the proportion of ureteric and bladder
injuries detected intraoperatively without routine cystoscopy is approximately
18% and 79%, respectively. However, when cystoscopy is performed, the
proportion of ureteric or bladder injuries detected intraoperatively increases
to approximately 95%.
What were the study strengths and weaknesses?
The study combines pooled data from a total of 79 studies but the the majority of studies were retrospective
which lowers postoperative injury detection rates.
What are the “practice essentials” learned from the study?
The study concludes that until more evidence is accumulated,
the clinicians should learn the skills and maintain a low threshold for performing
cystoscopy selectively in any cases in which there is suspicion of ureteric or
bladder injury.
References:
