Iatrogenic lower urinary tract injury at the time of pelvic reconstructive surgery: does previous pelvic surgery increase the risk?

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• 作者：Docile Saguan (1)
  Gina Northington (2)
  Orawee Chinthakanan (3)
  Catherine Hudson (2)
  Deborah Karp (2)
  
• 关键词：Gynecological surgery ; Lower urinary tract injury ; Pelvic reconstructive surgery
• 刊名：International Urogynecology Journal
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：25
• 期：8
• 页码：1041-1046
• 全文大小：190 KB
• 参考文献：1. Dowling RA, Corriere JN, Sandler CM (1986) Iatrogenic ureteral injury. J Urol 135:912-15
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  13. Barber MD, Visco AG, Weidner AC et al (2000) Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol 183:1402-410 CrossRef
  
• 作者单位：Docile Saguan (1)
  Gina Northington (2)
  Orawee Chinthakanan (3)
  Catherine Hudson (2)
  Deborah Karp (2)
  
  1. Urogynecology & Pelvic Reconstructive Surgery, The Southeast Permanente Medical Group, Inc., Southwood Medical Center, 2400 Mount Zion Parkway, Jonesboro, GA, 30236, USA
  2. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology/Obstetrics, Emory University School of Medicine, 1639 Pierce Drive, Room 4305, Atlanta, GA, 30322, USA
  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intracarorot Road, Sripoom, Chiang Mai, Thailand, 50200
  
• ISSN：1433-3023

文摘

Introduction and hypothesis The objective of this study was to evaluate whether a history of previous pelvic surgery is associated with lower urinary tract (LUT) injury at the time of pelvic reconstructive surgery (PRS). Methods A retrospective analysis of patients undergoing pelvic reconstructive surgery from 2006 to 2011 was performed. Patients were divided into two groups: those with previous pelvic surgery and those without previous pelvic surgery. A sample size analysis was performed to determine the number needed to detect at least a 3-fold difference in the rate of LUT injury. Demographic, historical, clinical, intraoperative, and postoperative data were analyzed. Associations between LUT injury and demographics, previous pelvic surgery, or other clinical risk factors were assessed using univariate and multivariate analyses. Results 685 women were included in the analysis: 514 (74.9?%) with and 171 (25.1?%) without prior pelvic surgery. The overall rate of LUT injury was 6?%. Of the injuries, 3.2?% were cystotomies, and 1.9?% were ureteral obstructions. Previous pelvic surgery did not significantly affect the rate of LUT injury (OR 0.76, 95%CI 0.38-.54). A diagnosis of prolapse, concurrent hysterectomy, anterior repair, and apical repair were significantly associated with LUT injury. After controlling for age and race, a diagnosis of prolapse remained significantly associated with LUT injury (OR 3.38, 95?% CI 1.11-4.75). Conclusions Prior pelvic surgery does not affect the rate of LUT injury in pelvic reconstructive surgery. The diagnosis of prolapse is a risk factor for LUT injury in women undergoing pelvic reconstructive surgery.