LAS VEGAS – Urinary tract injury occurs in an estimated 1.3% of laparoscopic hysterectomies, with ureteral injuries about as common as bladder injuries, results from large analysis of HMO patients showed.
"Given the rising popularity of minimally invasive surgery, laparoscopic hysterectomy has emerged as one of the modalities of choice for benign gynecologic hysterectomies," Dr. Jasmine Tan-Kim said in a poster presented at the annual meeting of the American Urogynecologic Society. "This increase in popularity is largely attributable to the decreased pain, length of hospital stay, and shorter postoperative recovery when compared to abdominal hysterectomy."
In an effort to evaluate the incidence, detection, and characteristics of urinary tract injury with total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy, Dr. Kim and her associates retrospectively analyzed data from 3,523 patients who underwent laparoscopic hysterectomy at Kaiser Permanente San Diego Medical Center from 2001 to 2012. They collected demographic characteristics, surgical techniques, and intra- and post-operative complications, using multivariable logistic regression to assess the independent risk factors for ureteral or bladder injury.
The mean age of patients was 46 years, their median body mass index was 29 kg/m2, and 20% had intraoperative cystoscopy.
The overall incidence of urinary tract injury was 1.3%. Of the 46 injuries, 19 (0.54%) were ureteral, 25 (0.71%) were bladder injuries, and two (0.06%) were both, reported Dr. Kim of the division of female pelvic medicine and reconstructive surgery at Kaiser Permanente, San Diego.
In more than half (57%) of urinary tract injury cases, the repair was performed by gynecologists, gynecologic oncologists, or urogynecologists, while the remainder (43%) were performed by urologists. There was no difference between total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy in terms of risk of ureteral or bladder injury, Dr. Kim said.
Of the 21 ureteral injuries, 71% were diagnosed postoperatively and 29% were diagnosed intraoperatively. Of the 27 bladder injuries, 85% were identified intraoperatively and 15% were identified postoperatively.
The regression analysis revealed that risk factors significantly associated with ureteral injury were a BMI of 26-30 kg/m2 (odds ratio, 4.07) and African American ethnicity (OR, 3.14). Risk factors significantly associated with bladder injury were BMI less than 26 kg/m2 (OR, 3.86), presence of endometriosis (OR, 2.85), and nulliparity (OR, 0.27 for no deliveries vs. two deliveries and OR, 0.11 for no deliveries vs. three or more deliveries).
The researchers stated that they had no relevant financial disclosures.