Lower urinary tract injury during the Burch procedure: Is there a role forroutine cystoscopy?

OBJECTIVE: This study was undertaken to evaluate the use of intraoperative cystoscopy for the detection of incidental bladder or ureteral injuries dur ing abdominal urethropexy procedures and to determine whether the incidence of injuries warrants the routine use of cystoscopy. METHODS: We reviewed the medical records of 109 consecutive patients who un derwent abdominal urethropexy procedures between November 1990 and February 1996 at a teaching institution. Each underwent intraoperative cystoscopy. We determined the incidence of cystotomy and ureteral obstruction and attem pted to determine surgical factors that might be associated with an increas ed risk of injury. RESULTS: Ten of 109 patients (9%) had bladder or ureteral injury, including 1 cystotomy during retropubic dissection, 6 cases of a transvesical suture noted during cystoscopy, 1 cystotomy recognized before closure, 1 case of ureteral obstruction found during cystoscopy, and 1 case of ureteral obstru ction not recognized at cystoscopy. Cystoscopy allowed detection of 7 of 9 (78%) otherwise unrecognized events. The only injury that resulted in signi ficant postoperative morbidity was the unrecognized ureteral obstruction. T here was no association between incidence of lower urinary tract injuries a nd surgical risk factors. CONCLUSION: Intraoperative bladder or ureteral injuries during urethropexy procedures are not uncommon, with an incidence of 9% in our series. There i s minimal morbidity if these injuries are detected and corrected during the operation, whereas morbidity may be significant if they remain unrecognize d. With a potential for unrecognized injury in 8% of Burch procedures witho ut the use of cystoscopy, routine use of cystoscopy during urethropexy proc edures appears to be warranted.