SIU-WJU Article of the Month – Jan 2019
Genitourinary Injuries During Benign Hysterectomy: Sequalae of Vaginal, Abdominal, and "Minimally Invasive" Surgical Approaches
SIU Academy®. Nikolavsky D. Jan 1, 2019; 256996 Topic: Complications/comorbidities
Dr. Dmitriy Nikolavsky
Dr. Dmitriy Nikolavsky
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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 sur-gery = 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 elu-cidate 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.


Hysterectomy | Bladder injury | Ureteral injury | Population analysis
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