THE VALUE OF INTRAOPERATIVE CYSTOSCOPY IN UROGYNECOLOGIC AND RECONSTRUCTIVE PELVIC-SURGERY

OBJECTIVE: Our goal was to evaluate the role of intraoperative cystosc opy during surgery for pelvic organ prolapse and urinary incontinence. STUDY DESIGN: Charts of 224 consecutive patients who had intraoperati ve cystoscopy performed after urogynecologic surgery were reviewed. RE SULTS: Nine injuries occurred that were unsuspected before cystoscopy, for an incidence of 4%. Six ureteral ligations occurred, four after B urch cystourethropexy and two after vaginal culdoplasty. Intravesical sutures were noted after two Burch procedures, and another injury occu rred with passage of fascia lata through the bladder during a pubovagi nal sling procedure. Eight injuries were managed by removal and replac ement of the suture or sling with only one requiring ureteroneocystoto my. When patients with injuries were compared with those without, ther e were no statistical differences in demographic or surgical parameter s. CONCLUSIONS: The potential for damage to the lower urinary tract is significant with complex urogynecologic surgery. Because of the incre ased and delayed morbidity associated with unrecognized injury, intrao perative surveillance cystoscopy should be considered a part of all su ch procedures.