Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

Luchristt, Douglas; Geynisman‐Tan, Julia; Mueller, Margaret; Kenton, Kimberly

doi:10.1016/j.jmig.2020.12.004

Cited by 8 publications

(12 citation statements)

References 53 publications

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“…16 Cystoscopy's capacity to discover damage that would otherwise go undetected by a simple visual check, allowing for rapid treatment and a reduction in morbidity and potential litigation, should stimulate more widespread use. 17 Cystoscopy of the lower urinary tract should be readily available to gynaecology surgeons doing a laparoscopic hysterectomy, according to the AAGL (advancing minimally invasive gynaecology worldwide). Cystoscopy should be used routinely during laparoscopic complete hysterectomy, according to surgeons and institutions.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist

Mishra

Solanki

Aggarwal

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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Background: The goal of this study is to find out: how important it is to utilize intraoperative cystoscopy liberally in normal gynaecological procedures to detect urinary tract injuries, how long it takes to do intraoperative cystoscopy and what problems are linked with cystoscopy.Materials: The study is from the year 2016 to 2022 involving around 1221 patients. In a tertiary care facility, retrospective observational research was conducted. The study comprised patients receiving all gynaecological and urogynaecological operations. Malignancy was ruled out. Following gynaecological surgery, a 20-F-30-degree telescope was used to perform a cystourethroscopy. To record case information, a study proforma was created.Results: Intraoperative cystoscopy detected four bladder injuries during anti-incontinence surgery (TVT) and hysterectomy. After a thorough laparoscopic hysterectomy with normal cystoscopy, one patient returned one month later with right ureteric injury. A urinary tract infection struck fifteen people shortly after surgery. After surgery, one patient suffered flank pain and a fever for 48 hours. There was no sign of urinary tract injury on a CT-IVP scan. She was handled with care.Conclusions: For early diagnosis of urinary tract injuries, gynaecologists should have a low threshold for performing intraoperative cystoscopy during gynaecological procedures. Early detection and treatment of urinary tract injuries reduces the patient's morbidity, with a successful repair outcome at the time of detection. Performing an intraoperative cystoscopy during gynaecological procedures allows for this.

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Section: Discussionmentioning

confidence: 99%

Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist

Mishra

Solanki

Aggarwal

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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show abstract

“… 5 A recent cost-effective analysis of routine cystoscopy favors the use of diagnostic cystoscopy following laparoscopic hysterectomy. 6 However, in one retrospective study, routine cystoscopy was performed after 20% of laparoscopic hysterectomy for benign indications. 7 At our practice, we perform diagnostic cystoscopy after every minimally-invasive hysterectomy.…”

Section: Case Seriesmentioning

confidence: 99%

Incidental Bladder Cancer at the Time of Routine Cystoscopy following Laparoscopic Hysterectomy

Zhang

Loring

2022

JSLS

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“…Given that POP reconstructive surgery is performed in 200,000 people annually, and 600,000 hysterectomies are performed annually, 5 many of which are performed for POP, GUTI may complicate a significant proportion of these cases. This in turn can lead to significant morbidity such as renal failure, fistula formation, and sepsis 6,7 . In addition, the cost of ureteral injury may exceed $10,000 per patient, thus presenting a significant economic, as well as individual health burden.…”

mentioning

confidence: 99%

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Sheyn¹,

Gupta

Boyd

et al. 2022

Female Pelvic Med Reconstr Surg

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Importance The rate of genitourinary tract injury (GUTI) following pelvic organ prolapse (POP) surgery is presently ill-defined and based on relatively small trials with short follow-up time. Given the potential for higher risk of injury with POP, a better understanding of this type of injury is important for patient counseling. Objectives The objective of this study was to identify the incidence and risk factors of GUTI related to POP surgery. Study Design Women undergoing POP surgery between 2010 and 2019 were identified using Current Procedural Terminology codes in the Premier Healthcare Database. The primary outcome was GUTI, defined as bladder or ureteral injury, and vesicovaginal or ureterovaginal fistula within 1 year of surgery. Genitourinary tract injury was identified using International Classification of Diseases and Current Procedural Terminology codes. Patients were divided into those with and without GUTI. Differences between groups were evaluated using the Student t test, Wilcoxon rank-sum test, and Fisher exact test as appropriate. Multivariable logistic regression was used to evaluate the independent predictors of GUTI. Results One hundred thirty-nine thousand one hundred fifty-eight surgical procedures for POP were captured between 2010 and 2019. The rate of GUTI was 1.10%: 0.48% bladder, 0.64% ureteral injuries, and 0.01% fistulas. The most significant variables associated with any GUTI were as follows: adhesiolysis (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.07–6.51), blood transfusion (aOR, 3.67; 95% CI, 1.34–10.04), and low-volume surgeons (<12 cases per year) (aOR, 1.68; 95% CI, 1.60–1.77), nonurologic or gynecologic surgeon specialty (aOR, 1.62; 95% CI, 1.49–2.00), and uterosacral suspension (aOR, 1.30; 95% CI, 1.13–1.49). Conclusions The rate of GUTI following POP surgery is lower than has previously been reported. Surgeon experience and specialty and surgical approach may affect GUTI incidence.

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Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

Cited by 8 publications

References 53 publications

Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist

Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist

Incidental Bladder Cancer at the Time of Routine Cystoscopy following Laparoscopic Hysterectomy

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

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