. 2014 May;210(5):480.e1-8.

doi: 10.1016/j.ajog.2013.12.040. Epub 2013 Dec 28.

Findings of universal cystoscopy at incontinence surgery and their sequelae

Halina M Zyczynski¹, Larry T Sirls², W Jerod Greer³, David D Rahn⁴, Elizabeth Casiano⁵, Peggy Norton⁶, Hae-Young Kim⁷, Linda Brubaker⁸; Urinary Incontinence Treatment Network

Collaborators, Affiliations

Collaborators

Urinary Incontinence Treatment Network:
William Steers, Veronica Mallett, Linda Brubaker, MaryPat FitzGerald, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Peggy Norton, David Lesser, Sharon Tennstedt, Anne Stoddard, Debuene Chang, John W Kusek, Leroy M Nyberg, Anne M Weber, Rowell S Ashford 2nd, Jan Baker, Diane Borello-France, Kathryn L Burgio, Seine Chiang, Ash Dabbous, Patricia S, Lee N Hammontree, Kimberly Kenton, Salil Khandwala, Karl Luber, Emily Lukacz, Shawn Menefee, Kenneth Peters, Joseph Schaffer, Amanda Simsiman, Larry Sirls, Robert Starr, R Edward, Rosemary Bradt, Julie E Burge, Karen Debes, Rosanna Dinh, Judy Gruss, Lynn Hall, Alice Howell, Kathy Jesse, D Lynn, Kathryn Koches, Barbara Leemon, Elva Kelly Moore, Shelly O'Meara, Janese Parent, Norma Pope, Caren Prather, Terry Rogers, Sylvia Sluder, Mary Tulke, Kimberly J Dandreo, Corinne J Leifer, Susan M McDermott, Anne Stoddard, Sharon Tennstedt, Liane Tinsley, Lisa Wruck, Yan Xu, Paul Abrams, J Quentin, William Henderson, Dee Fenner, Ann Arbor MI, Sheryl Kelsey, Jacek Mostwin, Bassem Wadie, Ann Gormley, Larry Sirls, Salil Khandwala, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Thomas Rozanski, Peggy Norton, Anne Stoddard, Debuene Chang, John Kusek, Amy Arisco, Jan Baker, Diane Borello-France, L Burgio, Ananias Diokno, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Yvonne Hsu, Jerry Lowder, Emily Lukacz, Shawn Menefee, Pamela Moalli, Leslie Rickey, Elizabeth Sagan, Joseph Schaffer, Robert Starr, Gary Sutkin, R Edward Varner, Julie E Burge, Laura Burr, JoAnn Columbo, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, D Lynn Kalinoski, Barbara Leemon, Karen Mislanovich, Elva Kelly, Caren Prather, Tia Thrasher, Mary Tulke, Robin Willingham, Kathleen Cannon, Kimberly J Dandreo, Liyuan Huang, Heather Litman, Marina Mihova, Anne Stoddard, Kerry Tanwar, Yan Xu, J Quentin Clemens, Paul Abrams, Timothy B Boone, John Connett, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters, Ann Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Peggy Norton, Anne Stoddard, Debuene Chang, John Kusek, Cindy Amundsen, Matthew Barber, Cheryl Iglesia, Lily Arya, Alexander Gomelsky, Kathryn L Burgio, Melissa Fischer, MaryPat Fitzgerald, Patricia S Goode, Robert L Holley, Yvonne Hsu, Margie Kahn, Jerry Lowder, Karl Luber, Emily Lukacz, Alayne Markland, Pamela Moalli, Elizabeth Mueller, Kenneth Peters, Thomas Rozanski, Joseph Schaffer, Gary Sutkin, R Edward Varner, Emily Whitcomb, S Wilson, Julie E Burge, Laura Burr, JoAnn Columbo, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, Michelle Kinglee, Barbara Leemon, Jean Maynor, Karen Mislanovich, Doni Murphy, Caren Prather, Mary Raynor, Elle Rich, Jennifer Tabaldo, Mary Tulke, Gisselle Zazueta-Damian, Kimberly J Dandreo, Rose Kowalski, Marina Mihova, Chad Morin, Anne Stoddard, Kerry Tanwar, Yan Xu, J Quentin Clemens, Paul Abrams, Timothy B, John Connett, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters

Affiliations

¹ Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA.
² Department of Urology, William Beaumont Hospital, Royal Oak, MI.
³ Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
⁴ Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School at Dallas, Dallas, TX.
⁵ Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
⁶ Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
⁷ New England Research Institutes, Watertown, MA.
⁸ Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL.

PMID: 24380742
PMCID: PMC4011936
DOI: 10.1016/j.ajog.2013.12.040

Findings of universal cystoscopy at incontinence surgery and their sequelae

Halina M Zyczynski et al. Am J Obstet Gynecol. 2014 May.

. 2014 May;210(5):480.e1-8.

doi: 10.1016/j.ajog.2013.12.040. Epub 2013 Dec 28.

Authors

Halina M Zyczynski¹, Larry T Sirls², W Jerod Greer³, David D Rahn⁴, Elizabeth Casiano⁵, Peggy Norton⁶, Hae-Young Kim⁷, Linda Brubaker⁸; Urinary Incontinence Treatment Network

Collaborators

Urinary Incontinence Treatment Network:
William Steers, Veronica Mallett, Linda Brubaker, MaryPat FitzGerald, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Peggy Norton, David Lesser, Sharon Tennstedt, Anne Stoddard, Debuene Chang, John W Kusek, Leroy M Nyberg, Anne M Weber, Rowell S Ashford 2nd, Jan Baker, Diane Borello-France, Kathryn L Burgio, Seine Chiang, Ash Dabbous, Patricia S, Lee N Hammontree, Kimberly Kenton, Salil Khandwala, Karl Luber, Emily Lukacz, Shawn Menefee, Kenneth Peters, Joseph Schaffer, Amanda Simsiman, Larry Sirls, Robert Starr, R Edward, Rosemary Bradt, Julie E Burge, Karen Debes, Rosanna Dinh, Judy Gruss, Lynn Hall, Alice Howell, Kathy Jesse, D Lynn, Kathryn Koches, Barbara Leemon, Elva Kelly Moore, Shelly O'Meara, Janese Parent, Norma Pope, Caren Prather, Terry Rogers, Sylvia Sluder, Mary Tulke, Kimberly J Dandreo, Corinne J Leifer, Susan M McDermott, Anne Stoddard, Sharon Tennstedt, Liane Tinsley, Lisa Wruck, Yan Xu, Paul Abrams, J Quentin, William Henderson, Dee Fenner, Ann Arbor MI, Sheryl Kelsey, Jacek Mostwin, Bassem Wadie, Ann Gormley, Larry Sirls, Salil Khandwala, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Thomas Rozanski, Peggy Norton, Anne Stoddard, Debuene Chang, John Kusek, Amy Arisco, Jan Baker, Diane Borello-France, L Burgio, Ananias Diokno, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Yvonne Hsu, Jerry Lowder, Emily Lukacz, Shawn Menefee, Pamela Moalli, Leslie Rickey, Elizabeth Sagan, Joseph Schaffer, Robert Starr, Gary Sutkin, R Edward Varner, Julie E Burge, Laura Burr, JoAnn Columbo, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, D Lynn Kalinoski, Barbara Leemon, Karen Mislanovich, Elva Kelly, Caren Prather, Tia Thrasher, Mary Tulke, Robin Willingham, Kathleen Cannon, Kimberly J Dandreo, Liyuan Huang, Heather Litman, Marina Mihova, Anne Stoddard, Kerry Tanwar, Yan Xu, J Quentin Clemens, Paul Abrams, Timothy B Boone, John Connett, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters, Ann Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Peggy Norton, Anne Stoddard, Debuene Chang, John Kusek, Cindy Amundsen, Matthew Barber, Cheryl Iglesia, Lily Arya, Alexander Gomelsky, Kathryn L Burgio, Melissa Fischer, MaryPat Fitzgerald, Patricia S Goode, Robert L Holley, Yvonne Hsu, Margie Kahn, Jerry Lowder, Karl Luber, Emily Lukacz, Alayne Markland, Pamela Moalli, Elizabeth Mueller, Kenneth Peters, Thomas Rozanski, Joseph Schaffer, Gary Sutkin, R Edward Varner, Emily Whitcomb, S Wilson, Julie E Burge, Laura Burr, JoAnn Columbo, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, Michelle Kinglee, Barbara Leemon, Jean Maynor, Karen Mislanovich, Doni Murphy, Caren Prather, Mary Raynor, Elle Rich, Jennifer Tabaldo, Mary Tulke, Gisselle Zazueta-Damian, Kimberly J Dandreo, Rose Kowalski, Marina Mihova, Chad Morin, Anne Stoddard, Kerry Tanwar, Yan Xu, J Quentin Clemens, Paul Abrams, Timothy B, John Connett, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters

Affiliations

¹ Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA.
² Department of Urology, William Beaumont Hospital, Royal Oak, MI.
³ Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
⁴ Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School at Dallas, Dallas, TX.
⁵ Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
⁶ Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
⁷ New England Research Institutes, Watertown, MA.
⁸ Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL.

PMID: 24380742
PMCID: PMC4011936
DOI: 10.1016/j.ajog.2013.12.040

Abstract

Objective: The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury.

Study design: Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed.

Results: Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling (MUS) procedures (6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P = .01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P < .001), they did not differ in overall success, voiding dysfunction, recurrent urinary tract infections, or urge urinary incontinence.

Conclusion: Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae.

Keywords: cystoscopy; iatrogenic bladder injury; incontinence surgery.

PubMed Disclaimer

Conflict of interest statement

H.M.Z. and L.T.S. are consultants for Johnson & Johnson. The other authors report no conflict of interest.

References

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Findings of universal cystoscopy at incontinence surgery and their sequelae

Collaborators

Affiliations

Findings of universal cystoscopy at incontinence surgery and their sequelae

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical