Department of Urology, Columbia University Medical Center, 161 Ft. Washington Ave 11th Floor, New York, NY, 10032, USA.
Department of Biostatistics, Columbia University Medical Center, New York, NY, USA.
World J Urol. 2020 Aug;38(8):2049-2054. doi: 10.1007/s00345-018-2541-y. Epub 2018 Nov 7.
Hysterectomy (Hys) is the most common non-urologic surgery associated with iatrogenic genitourinary (GU) injury. We present the largest known population-based evaluation of GU injury related to benign Hys.
The New York Statewide Planning and Research Cooperative System (SPARCS) was queried by ICD-9 and CPT codes. SPARCS for women from 1995 to 2014, who underwent laparoscopic or robotic Hys (minimally invasive surgery = MIS), abdominal Hys (AH), and vaginal Hys (VH) for benign diagnoses. Bladder and ureteral repairs were captured based on the procedure codes. Codes for ureteroneocystotomy (UNC) were compared to any other ureteral repairs, to elucidate injury patterns. Statistical analysis was conducted using Chi squared test, ANOVA, Mann-Whitney test and Poisson Regression and multivariable analysis were performed.
516,340 women underwent Hys for a benign etiology. 69% were AH, 25% VH, and 6% were MIS. 7490 patients (1.45%) had a concomitant GU injury. Compared to VH, MIS and AH were associated with greater odds of bladder and ureteral injury (p < 0.001). MIS and AH, compared to VH, were associated with reduced odds of UNC compared to complex reconstruction (OR 0.27, p < 0.001 and OR 0.12, p < 0.00, respectively). The injured cohort had higher total mean charges ($29,889 vs $15,808) and length of hospitalization (6.32 vs 3.56 days) (p < 0.001).
Bladder and ureteral injuries during hysterectomy are uncommon in contemporary practice and are lower than historical rates. GU injury increases hospitalization cost. VH is associated with the lowest rate of GU injury, and thus appears to be a valuable approach, when feasible.
子宫切除术（Hys）是最常见的与医源性泌尿生殖系统（GU）损伤相关的非泌尿科手术。我们提出了迄今为止最大的基于人群的良性 Hys 相关 GU 损伤评估。
通过 ICD-9 和 CPT 代码对纽约州全州规划和研究合作系统（SPARCS）进行了查询。SPARCS 对 1995 年至 2014 年间因良性诊断接受腹腔镜或机器人 Hys（微创手术 = MIS）、腹式 Hys（AH）和阴道 Hys（VH）的女性进行了研究。根据手术代码捕捉到膀胱和输尿管修复。将输尿管吻合术（UNC）的代码与任何其他输尿管修复的代码进行比较，以阐明损伤模式。使用卡方检验、方差分析、Mann-Whitney 检验和泊松回归进行统计分析，并进行了多变量分析。
516,340 名女性因良性病因接受了 Hys 治疗。69%为 AH，25%为 VH，6%为 MIS。7490 名患者（1.45%）同时发生 GU 损伤。与 VH 相比，MIS 和 AH 与膀胱和输尿管损伤的几率更高相关（p < 0.001）。与 VH 相比，MIS 和 AH 与 UNC 相比，与复杂重建相比，UNC 的几率降低（OR 0.27，p < 0.001 和 OR 0.12，p < 0.00，分别）。受伤组的总平均费用（$29,889 与 $15,808）和住院时间（6.32 与 3.56 天）（p < 0.001）更高。
在当代实践中，子宫切除术期间的膀胱和输尿管损伤并不常见，且低于历史水平。GU 损伤增加了住院费用。VH 与 GU 损伤率最低相关，因此在可行时似乎是一种有价值的方法。
