Gynecologic Oncology, Karmanos Cancer Center, Detroit, Michigan, USA
Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Int J Gynecol Cancer. 2022 Jan;32(1):62-68. doi: 10.1136/ijgc-2021-003073. Epub 2021 Nov 3.
Guidance regarding the use of cystoscopy at the time of hysterectomy is lacking in gynecologic oncology. We compare the rate of delayed urinary tract injury in women who underwent cystoscopy at the time of hysterectomy performed by a gynecologic oncologist for benign or malignant indication with those who did not.
This was a retrospective cohort study of patients who had a hysterectomy performed by a gynecologic oncologist recorded in the National Surgical Quality Improvement Program between January 2014 and December 2017. The primary outcome was delayed urinary tract injury in the 30-day post-operative period. Secondary outcomes were operative time and urinary tract infection rate. The exposure of interest was cystoscopy at the time of hysterectomy and bivariable tests were used to examine associations.
We identified 33 355 women who underwent hysterectomy for benign (41%; n=13 621) or malignant (59%; n=19 734) indications performed by a gynecologic oncologist. Surgical approach was open (39%; n=12 974), laparoscopic or robotic-assisted laparoscopic (55%; n=18 272), and vaginal or vaginally-assisted (6%; n=2109). Overall, 12% of women (n=3873) underwent cystoscopy at the time of surgery; cystoscopy was more commonly performed in laparoscopic (15%; n=2829) and vaginal (12%; n=243) approaches than with open hysterectomy (6%; n=801) (p<0.001). There was no difference in the rate of delayed urinary tract injury in patients who underwent cystoscopy at the time of surgery compared with those who did not (0.4% vs 0.3%, p=0.32). However, patients who underwent cystoscopy were more likely to be diagnosed with a urinary tract infection (3% vs 2%, RR 1.3, 95% CI 1.1 to 1.6). In cases where cystoscopy was performed, median operative time was increased by 9 min (137 vs 128 min, p<0.001).
Cystoscopy at the time of hysterectomy performed by a gynecologic oncologist does not result in a lower rate of delayed urinary tract injury compared with no cystoscopy.
妇科肿瘤学领域缺乏关于在子宫切除术时使用膀胱镜检查的指导。我们比较了由妇科肿瘤学家为良性或恶性指征进行子宫切除术时行膀胱镜检查的女性与未行膀胱镜检查的女性发生延迟性尿路损伤的比率。
这是一项回顾性队列研究，纳入了在 2014 年 1 月至 2017 年 12 月期间在国家手术质量改进计划中记录的由妇科肿瘤学家进行的子宫切除术患者。主要结局为术后 30 天内发生延迟性尿路损伤。次要结局为手术时间和尿路感染率。研究的暴露因素为子宫切除术中行膀胱镜检查，采用两变量检验来检查关联。
我们确定了 33355 名因良性（41%；n=13621）或恶性（59%；n=19734）指征由妇科肿瘤学家进行子宫切除术的女性。手术方式为开腹（39%；n=12974）、腹腔镜或机器人辅助腹腔镜（55%；n=18272）和阴道或经阴道辅助（6%；n=2109）。总体而言，12%的女性（n=3873）在手术时行膀胱镜检查；与开腹子宫切除术相比，腹腔镜（15%；n=2829）和阴道（12%；n=243）途径更常进行膀胱镜检查（p<0.001）。在手术时行膀胱镜检查的患者与未行膀胱镜检查的患者相比，延迟性尿路损伤的发生率无差异（0.4%比 0.3%，p=0.32）。然而，行膀胱镜检查的患者更可能被诊断为尿路感染（3%比 2%，RR 1.3，95%CI 1.1 至 1.6）。在进行膀胱镜检查的情况下，手术时间中位数增加了 9 分钟（137 分钟比 128 分钟，p<0.001）。
与不进行膀胱镜检查相比，由妇科肿瘤学家在子宫切除术中行膀胱镜检查并不会降低延迟性尿路损伤的发生率。
