Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Drs. Misal, Wright, Greene, and Siedhoff).
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN.
J Minim Invasive Gynecol. 2021 Feb;28(2):282-287. doi: 10.1016/j.jmig.2020.05.023. Epub 2020 May 29.
Compare odds of postoperative urinary symptoms in women who had cystoscopy after benign laparoscopic hysterectomy with 50% dextrose and with normal saline solution with intravenous indigo carmine.
Retrospective cohort study.
Two tertiary care centers.
All women who underwent benign laparoscopic hysterectomy and intraoperative cystoscopy carried out by a single surgeon.
We compared postoperative urinary symptoms in patients who received 50% dextrose cystoscopy fluid (January 2016-June 2017) with those who received saline cystoscopy with intravenous indigo carmine (November 2013-April 2014).
A total of 96 patients had cystoscopy with 50% dextrose and 104 with normal saline with intravenous indigo carmine. Differences in baseline characteristics of the two groups of participants mainly reflected institutional population diversity: age (45.2 vs 41.9, p = .01), body mass index (26.9 vs 33.4, p <.01), race, current smoking status (1% vs 7.8%, p = .04), diabetes (2.1% vs 11.5%, p = .01), history of abdominal surgery (53.1% vs 74%, p <.01), hysterectomy type, receipt of intraoperative antibiotics (92.7% vs 100%, p <.01), recatheterization (10.4% vs 0%, p <.01), and removal of catheter on postoperative day 0 (66.7% vs 12.5%, p <.01). Urinary symptoms were similar for 50% dextrose and saline (12.5% vs 7.7%, p = .19). After adjusting for age, body mass index, race, diabetes, and day of catheter removal, there remained no significant differences in urinary symptoms between the groups (odds ratio 3.19 [95% confidence interval, 0.82-12.35], p = .09). One immediate bladder injury was detected in the saline group and 1 delayed lower urinary tract injury in the 50% dextrose group.
Overall, most women experienced no urinary symptoms after benign laparoscopic hysterectomy. There were no significant differences in postoperative urinary symptoms or empiric treatment of urinary tract infection after the use of 50% dextrose cystoscopy fluid as compared with normal saline. The previous finding of increased odds of urinary tract infection after dextrose cystoscopy may be due to use in a high-risk population.
比较在良性腹腔镜子宫切除术后接受 50%葡萄糖和生理盐水静脉注射靛胭脂膀胱镜检查的女性术后尿症状的几率。
回顾性队列研究。
两个三级保健中心。
所有接受良性腹腔镜子宫切除术和单一外科医生进行的术中膀胱镜检查的女性。
我们比较了接受 50%葡萄糖膀胱镜检查液（2016 年 1 月至 2017 年 6 月）和接受生理盐水静脉注射靛胭脂膀胱镜检查的患者（2013 年 11 月至 2014 年 4 月）术后尿症状。
共有 96 名患者接受了 50%葡萄糖膀胱镜检查，104 名患者接受了生理盐水静脉注射靛胭脂膀胱镜检查。两组参与者的基线特征差异主要反映了机构人群的多样性：年龄（45.2 岁比 41.9 岁，p=0.01），体重指数（26.9 比 33.4，p<0.01），种族，当前吸烟状况（1%比 7.8%，p=0.04），糖尿病（2.1%比 11.5%，p=0.01），腹部手术史（53.1%比 74%，p<0.01），子宫切除术类型，术中使用抗生素（92.7%比 100%，p<0.01），再插管（10.4%比 0%，p<0.01），以及术后第 0 天拔管（66.7%比 12.5%，p<0.01）。50%葡萄糖和生理盐水的尿症状相似（12.5%比 7.7%，p=0.19）。在调整年龄、体重指数、种族、糖尿病和导管拔除日数后，两组间尿症状无显著差异（比值比 3.19[95%置信区间，0.82-12.35]，p=0.09）。在生理盐水组中检测到 1 例即刻膀胱损伤，在 50%葡萄糖组中检测到 1 例迟发性下尿路损伤。
总体而言，大多数女性在接受良性腹腔镜子宫切除术后没有出现尿症状。与使用生理盐水相比，50%葡萄糖膀胱镜检查液不会显著增加术后尿症状或经验性治疗尿路感染的几率。先前发现使用葡萄糖后尿路感染的几率增加可能是由于在高危人群中使用。
