Halina M Zyczynski1, Larry T Sirls2, W Jerod Greer3, David D Rahn4, Elizabeth Casiano5, Peggy Norton6, Hae-Young Kim7, Linda Brubaker8. 1. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA. 2. Department of Urology, William Beaumont Hospital, Royal Oak, MI. 3. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 4. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School at Dallas, Dallas, TX. 5. Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX. 6. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT. 7. New England Research Institutes, Watertown, MA. 8. Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL.
Abstract
OBJECTIVE: The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury. STUDY DESIGN: Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed. RESULTS: Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling (MUS) procedures (6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P = .01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P < .001), they did not differ in overall success, voiding dysfunction, recurrent urinary tract infections, or urge urinary incontinence. CONCLUSION: Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae.
OBJECTIVE: The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury. STUDY DESIGN: Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed. RESULTS: Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling (MUS) procedures (6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P = .01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P < .001), they did not differ in overall success, voiding dysfunction, recurrent urinary tract infections, or urge urinary incontinence. CONCLUSION: Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae.
Authors: Holly E Richter; Michael E Albo; Halina M Zyczynski; Kimberly Kenton; Peggy A Norton; Larry T Sirls; Stephen R Kraus; Toby C Chai; Gary E Lemack; Kimberly J Dandreo; R Edward Varner; Shawn Menefee; Chiara Ghetti; Linda Brubaker; Ingrid Nygaard; Salil Khandwala; Thomas A Rozanski; Harry Johnson; Joseph Schaffer; Anne M Stoddard; Robert L Holley; Charles W Nager; Pamela Moalli; Elizabeth Mueller; Amy M Arisco; Marlene Corton; Sharon Tennstedt; T Debuene Chang; E Ann Gormley; Heather J Litman Journal: N Engl J Med Date: 2010-05-17 Impact factor: 91.245
Authors: Roger R Dmochowski; Jerry M Blaivas; E Ann Gormley; Saad Juma; Mickey M Karram; Deborah J Lightner; Karl M Luber; Eric S Rovner; David R Staskin; J Christian Winters; Rodney A Appell; Linda E Whetter Journal: J Urol Date: 2010-03-29 Impact factor: 7.450
Authors: Michael E Albo; Holly E Richter; Linda Brubaker; Peggy Norton; Stephen R Kraus; Philippe E Zimmern; Toby C Chai; Halina Zyczynski; Ananias C Diokno; Sharon Tennstedt; Charles Nager; L Keith Lloyd; MaryPat FitzGerald; Gary E Lemack; Harry W Johnson; Wendy Leng; Veronica Mallett; Anne M Stoddard; Shawn Menefee; R Edward Varner; Kimberly Kenton; Pam Moalli; Larry Sirls; Kimberly J Dandreo; John W Kusek; Leroy M Nyberg; William Steers Journal: N Engl J Med Date: 2007-05-21 Impact factor: 91.245
Authors: Robert Abouassaly; Jordan R Steinberg; Marguerite Lemieux; Carlos Marois; Lawrence I Gilchrist; Jean-Louis Bourque; Le Mai Tu; Jacques Corcos Journal: BJU Int Date: 2004-07 Impact factor: 5.588