E-Posters-10209

10209_Bochenska

Pdf Summary

This study aimed to determine the incidence of lower urinary tract injury (LUTI) at the time of peripartum hysterectomy and evaluate the use of intraoperative cystoscopy in the identification of LUTI. The study involved a retrospective cohort of all peripartum hysterectomies performed at two women's hospitals between January 2010 and January 2015. A total of 197 women underwent peripartum hysterectomy during the study period, most of which were planned due to abnormal placenta placement. The cumulative LUTI rate for the cohort was 14.7%, with cystotomy being more common (12.2%) than ureteral injury (2.5%). Intraoperative cystoscopy was performed in 49.7% of patients, and most cases of LUTI were diagnosed through intraabdominal visualization of the bladder defect or ureteral injury. All cystotomies were repaired by primary closure, and the 3 cases of intraoperatively diagnosed ureteral injuries were repaired either by ureteroureterostomy or ureteroneocystostomy. Three cystotomies were not grossly identified intraoperatively but were diagnosed on cystoscopy at the conclusion of the procedure. The remaining 3 patients did not undergo intraoperative cystoscopy and presented with ureteral injury or cystotomy remote from the index surgery, requiring reoperation. The study suggests that one in seven women undergoing peripartum hysterectomy sustain a LUTI, and when cystoscopy is performed, all LUTI cases are identified at the time of surgery. Physicians performing peripartum hysterectomy should consider universal cystoscopy to reduce the morbidity associated with LUTI and increase detection.

Keywords

lower urinary tract injury

LUTI

peripartum hysterectomy

intraoperative cystoscopy

incidence

retrospective cohort

cystotomy

ureteral injury

primary closure

morbidity