Routine cystoscopy after laparoscopically assisted hysterectomy: what's the point?

Objective To define the role of routine cystoscopy following laparoscopical ly assisted hysterectomy in the early detection of ureteric injuries. Design A retrospective observational study based on casenote review. Subjects A consecutive series of 436 women who underwent routine video cyst oscopy after intrafascial laparoscopically assisted hysterectomy, with or w ithout bilateral salpingo-oophorectomy. Results In 436 cystoscope evaluations, six cases aroused suspicion of a ure teric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were det ected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative p rocedure; the remainder were not. Conclusion Routine cystoscopy at intrafascial laparoscopically assisted hys terectomy has not contributed to the early diagnosis and treatment of urete ric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endo-gynaecologi st should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.