Cystoscopy at the time of prolapse repair

ABSTRACT

Injury to the urinary tract can occur during surgical repair of anterior and apical pelvic organ prolapse. Cystoscopy at the time of surgical prolapse repair is a low-risk procedure that can identify genitourinary tract injury by inspecting the bladder and urethra as well as by visualizing the ureters and ureteral efflux. There are several techniques to assist with visualization of ureteral efflux. Identifying injury intraoperatively can mitigate the morbidity of the injury. Universal cystoscopy should be performed at the time of all pelvic reconstructive surgeries, with the exception of operations solely for posterior compartment defects.

Iatrogenic injury to the lower genitourinary tract can occur during pelvic organ prolapse reconstructive surgery including anterior vaginal wall, vaginal vault (with or without concomitant hysterectomy), and obliterative repairs. Identifying lower genitourinary tract injuries intraoperatively decreases morbidity. Failure to identify lower genitourinary tract injury at the time of surgery can lead to serious complications including peritonitis, fistula formation, and loss of renal function.^1,2 

Cystoscopy is useful in assessing bladder integrity and ureteral patency. Surgeons should perform intraoperative cystoscopy during any pelvic organ prolapse reconstructive surgery with risk to the bladder or ureters, as cystoscopy provides a mechanism by which iatrogenic lower genitourinary tract injury can be recognized and, in most cases, immediately managed, thereby minimizing morbidity.

RECOMMENDATIONS

• Cystoscopy can identify lower genitourinary tract injury intraoperatively and prevent patient morbidity. 

• Ureteral efflux should be confirmed when cystoscopy is performed during pelvic organ prolapse reconstructive surgery; multiple agents exist to aid with this if needed.

• Universal cystoscopy should be performed at the time of all pelvic organ prolapse reconstructive operations, with the exception of operations solely for posterior compartment defects.

This was created in partnership with the American Urogynecologic Society (AUGS). AUGS was established in 1979 and represents more than 1,900 members, including practicing physicians, nurse practitioners, physical therapists, nurses and health care professionals, and researchers from many disciplines. 

Full text of the consensus statement can be viewed HERE.

References:

• Brandes S, Coburn M, Armenakas N, et al. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004;94(3):277–289.

• Cohen AJ, Packiam VT, Nottingham CU, et al. Iatrogenic bladder injury: national analysis of 30-day outcomes. Urology 2016;97:250–256.