Erica J Chang1, Rachel S Mandelbaum1, David J Nusbaum1, Caroline J Violette1, Kazuhide Matsushima2, Maximilian Klar3, Shinya Matsuzaki1, Hiroko Machida4, Hiroyuki Kanao5, Lynda D Roman6, Koji Matsuo7. 1. Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette). 2. Acute Care Surgery (Dr. Matsushima). 3. Department of Obstetrics and Gynecology (Dr. Klar), University of Freiburg, Freiburg, Germany. 4. Department of Obstetrics and Gynecology (Dr. Machida), Tokai University School of Medicine, Kanagawa, Japan. 5. Department of Gynecologic Oncology (Dr. Kanao), Cancer Institute Hospital, Tokyo, Japan. 6. Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette); Norris Comprehensive Cancer Center (Drs. Roman and Matsuo), University of Southern California, Los Angeles, California. 7. Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology (Drs. Chang, Mandelbaum, Matsuzaki, Roman, and Matsuo, Mr. Nusbaum, and Ms. Violette); Norris Comprehensive Cancer Center (Drs. Roman and Matsuo), University of Southern California, Los Angeles, California. Electronic address: koji.matsuo@med.usc.edu.
Abstract
STUDY OBJECTIVE: The findings of previous studies have been inconsistent as to whether benign hysterectomy via minimally invasive laparoscopic surgery increases the risk of vesicoureteral injury when compared with laparotomy. The objectives of our study were to (1) examine the rate of vesicoureteral injury on benign hysterectomy by the surgical approach and (2) compare the risk of vesicoureteral injury specifically between minimally invasive laparoscopic and abdominal hysterectomy on a populational level. DESIGN: Retrospective population-based observational study. SETTING: The National Inpatient Sample. PATIENTS: A total of 501 110 women who had undergone hysterectomy for benign gynecologic disease between January 2012 and September 2015 were included as follows: total abdominal hysterectomy (TAH, n = 284 365 [56.7%]), total laparoscopic hysterectomy (TLH, n = 60 410 [12.1%]), abdominal supracervical hysterectomy (Abd-SCH, n = 55 655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n = 45 620 [9.1%]), total vaginal hysterectomy (TVH, n = 34 865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH, n = 20 195 [4.0%]). INTERVENTIONS: A comprehensive risk assessment for vesicoureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing was used to compare (1) TLH versus TAH and (2) LSC-SCH versus Abd-SCH with generalized estimating equations. In a sensitivity analysis, gynecologic disease-specific injury risk and vaginal route-specific injury risk (LAVH vs TVH) were assessed. MEASUREMENTS AND MAIN RESULTS: Vesicoureteral injury was reported in 1045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury rate, whereas LSC-SCH had the lowest (0.10%) (p <.001). TLH (0.13%) had the highest ureteral injury rate, whereas TAH had the lowest (0.04%) (p <.001). In propensity score inverse probability of treatment weighing models, compared with TAH, TLH was associated with an increased risk of ureteral injury (odds ratio [OR] 3.95, 95% confidence interval [CI] 2.03-7.67, p <.001) but not bladder injury (OR 1.04, 95% CI 0.57-1.90, p = .897). Risk of ureteral injury was particularly high when TLH was performed for endometriosis (OR 6.15, 95% CI 1.18-31.9, p = .031) or for uterine myoma (OR 4.15, 95% CI 2.13-8.11, p <.001). In contrast, for supracervical or vaginal hysterectomy, minimally invasive laparoscopic approaches were not associated with an increased risk of vesicoureteral injury (LSC-SCH vs Abd-SCH: OR 0.62, 95% CI 0.19-1.98, p = .419; LAVH vs TVH: OR 1.21, 95% CI 0.63-2.33, p = .564). CONCLUSION: The risk of vesicoureteral injury on benign hysterectomy is low overall regardless of hysterotomy modalities but varies widely with the surgical approach. Compared with TAH, TLH may be associated with an increased risk of ureteral injury.
STUDY OBJECTIVE: The findings of previous studies have been inconsistent as to whether benign hysterectomy via minimally invasive laparoscopic surgery increases the risk of vesicoureteral injury when compared with laparotomy. The objectives of our study were to (1) examine the rate of vesicoureteral injury on benign hysterectomy by the surgical approach and (2) compare the risk of vesicoureteral injury specifically between minimally invasive laparoscopic and abdominal hysterectomy on a populational level. DESIGN: Retrospective population-based observational study. SETTING: The National Inpatient Sample. PATIENTS: A total of 501 110 women who had undergone hysterectomy for benign gynecologic disease between January 2012 and September 2015 were included as follows: total abdominal hysterectomy (TAH, n = 284 365 [56.7%]), total laparoscopic hysterectomy (TLH, n = 60 410 [12.1%]), abdominal supracervical hysterectomy (Abd-SCH, n = 55 655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n = 45 620 [9.1%]), total vaginal hysterectomy (TVH, n = 34 865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH, n = 20 195 [4.0%]). INTERVENTIONS: A comprehensive risk assessment for vesicoureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing was used to compare (1) TLH versus TAH and (2) LSC-SCH versus Abd-SCH with generalized estimating equations. In a sensitivity analysis, gynecologic disease-specific injury risk and vaginal route-specific injury risk (LAVH vs TVH) were assessed. MEASUREMENTS AND MAIN RESULTS:Vesicoureteral injury was reported in 1045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury rate, whereas LSC-SCH had the lowest (0.10%) (p <.001). TLH (0.13%) had the highest ureteral injury rate, whereas TAH had the lowest (0.04%) (p <.001). In propensity score inverse probability of treatment weighing models, compared with TAH, TLH was associated with an increased risk of ureteral injury (odds ratio [OR] 3.95, 95% confidence interval [CI] 2.03-7.67, p <.001) but not bladder injury (OR 1.04, 95% CI 0.57-1.90, p = .897). Risk of ureteral injury was particularly high when TLH was performed for endometriosis (OR 6.15, 95% CI 1.18-31.9, p = .031) or for uterine myoma (OR 4.15, 95% CI 2.13-8.11, p <.001). In contrast, for supracervical or vaginal hysterectomy, minimally invasive laparoscopic approaches were not associated with an increased risk of vesicoureteral injury (LSC-SCH vs Abd-SCH: OR 0.62, 95% CI 0.19-1.98, p = .419; LAVH vs TVH: OR 1.21, 95% CI 0.63-2.33, p = .564). CONCLUSION: The risk of vesicoureteral injury on benign hysterectomy is low overall regardless of hysterotomy modalities but varies widely with the surgical approach. Compared with TAH, TLH may be associated with an increased risk of ureteral injury.
Authors: Babak Vakili; Ralph R Chesson; Brooke L Kyle; S Abbas Shobeiri; Karolynn T Echols; Richard Gist; Yong T Zheng; Thomas E Nolan Journal: Am J Obstet Gynecol Date: 2005-05 Impact factor: 8.661
Authors: Jack Hadley; K Robin Yabroff; Michael J Barrett; David F Penson; Christopher S Saigal; Arnold L Potosky Journal: J Natl Cancer Inst Date: 2010-10-13 Impact factor: 13.506
Authors: Okechukwu A Ibeanu; Ralph R Chesson; Karolynn T Echols; Mily Nieves; Fatuma Busangu; Thomas E Nolan Journal: Obstet Gynecol Date: 2009-01 Impact factor: 7.661
Authors: Jennifer M Wu; Mary Ellen Wechter; Elizabeth J Geller; Thao V Nguyen; Anthony G Visco Journal: Obstet Gynecol Date: 2007-11 Impact factor: 7.661