This article reviews the case histories of 236 patients who had cystos
copy as part of their major vaginal operations. Seven had cystoscopica
lly detected potential lower urinary tract injuries. Five of these inj
uries were ureteral obstructions, one occurring after anterior repair,
three associated with a McCall culdoplasty, and one associated with a
modified Pereyra bladder neck suspension. Two injuries were subtle cy
stotomies. These compromises of the lower urinary tract were detected
during the main operative procedure and immediately rectified. We prop
ose that routine intraoperative cystoscopy associated with intravenous
administration of indigo carmine is an excellent method for detecting
actual and potential lower urinary tract surgical injury. Cystoscopy
cannot distinguish which surgical distortion or injury will spontaneou
sly resolve. The identification of non-blood-tinged urine from both ur
eteral orifices and the absence of bladder trauma should eliminate the
possibility of lower urinary tract surgical injury, except for ischem
ic necrosis. Cystoscopy, like laparoscopy, is a procedure that should
benefit our patients and should not isolate a specialty.