Intraoperative cystoscopy in conjunction with anti-incontinence surgery

Objective: To determine the frequency of lower urinary tract injury detecte d by routine intraoperative cystoscopy after anti-incontinence surgery. Methods: We reviewed charts from women who had anti-incontinence surgery an d routine intraoperative cystoscopy done by a single surgeon from June 1, 1 995, to June 1, 1998, and assessed preoperative and intraoperative variable s. Results: We reviewed 351 patient records. Four records were incomplete and there were nine injuries in the other 347 cases (2.6%, 95% confidence inter val [CI] 1.2, 4.9). Four cystotomies occurred during laparoscopic Burch pro cedures and were detected before cystoscopy. Five injuries were detected at cystoscopy, a rate of 1.5% (95% CI 0.5, 3.4). Four injuries occurred durin g 161 pubovaginal sling procedures (2.5%, 95% CI 0.7, 6.2). One woman had s utures in her bladder from a prior procedure detected at cystoscopy. In 186 Burch procedures (48 laparoscopic, 138 open), there were no previously unr ecognized injuries detected by cystoscopy. All injuries were repaired durin g original surgery. It was not possible to assess preoperative and intraope rative risk factors because of the low rate of injury. Conclusion: The rate of injury to the lower urinary tract during anti-incon tinence surgery in this series was 2.6% (95% CI 1.2, 4.9). Injuries during Burch procedures were all detected before cystoscopy. (Obstet Gynecol 2000; 95:794-6. (C) 2000 by The American College of Obstetricians and Gynecologis ts).