AAGL Practice Report: Practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy.

Lower urinary tract injuries are a serious potential complication of laparoscopic hysterectomy. The risk of such injuries may be as high as 3%, and most, but not all, are detected at intraoperative cystoscopy. High-quality published data suggest a sensitivity of 80% to 90% for ureteral trauma. Among the injuries that may be missed are those related to the use of energy-based surgical tools that include ultrasound and radiofrequency electricity. Cystoscopic evaluation of the lower urinary tract should be readily available to gynecologic surgeons performing laparoscopic hysterectomy. To this end, it is essential that a surgeon with appropriate education, training, and institutional privileges be available without delay to perform this task. Currently available evidence supports cystoscopy at the time of laparoscopic hysterectomies. The rate of detectable but unsuspected lower urinary tract injuries is enough to suggest that surgeons consider cystoscopic evaluation following laparoscopic total hysterectomy as a routine procedure.