Routine Cystoscopy during Robotic Hysterectomy for Endometrial Cancer

Abstract

Background: The use of routine cystoscopy after hysterectomy is controversial.Objective: To evaluate the role of routine cystoscopy in the detection of urinary tract injuries in robotic total laparoscopic hysterectomies performed for endometrial cancer staging. Study design: This was a retrospective chart review of patients undergoing robotic-assisted laparoscopic hysterectomy for endometrial cancer staging by a single gynecologic oncologist between January 2012 and December 2015. Routine cystoscopy was performed in all cases. Results: A total of 157 cases met inclusion criteria and among those, five cases of urinary tract injury were identified (3.2%). Among the patients with urinary tract injury, average age was 66 [range 47, 90] years old, the average BMI was 34 [range 25, 34], and all patients had Stage I of endometrial cancer. Three patient injuries were detected intraoperatively, and 2 injuries were diagnosed postoperatively. Two of the intraoperative injuries were caused by dissection of the bladder from the lower uterine segment and detected prior to performing the cystoscopy. Another intraoperative injury was detected immediately after performing a mini-laparotomy to extract a larger uterus. The 2 urinary tract injury cases detected postoperatively were both ureteral injuries. The visual detection rate of the urinary tract injuries was 60% (3/5), while the cystoscopy detection rate was 0%. There were no significant differences detected in risk factors between the injury cases and the whole cohort. Conclusion: In this study, the incidence of urinary tract injury in robotic hysterectomy performed for endometrial cancer staging was 3.2%. Performing routine cystoscopy did not improve detection of urinary tract injuries in these cases.