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Bladder and ureteral injuries during benign hysterectomy: an observational cohort analysis in New York State

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Abstract

Purpose

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.

Methods

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 surgery = 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 elucidate injury patterns. Statistical analysis was conducted using Chi squared test, ANOVA, Mann–Whitney test and Poisson Regression and multivariable analysis were performed.

Results

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).

Conclusions

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.

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Authors and Affiliations

Authors

Contributions

CRB protocol/project development, manuscript writing. ST data collection and management. GL data analysis. DA-A data collection and management. SBB protocol/project development, manuscript editing.

Corresponding author

Correspondence to Steven B. Brandes.

Ethics declarations

Conflict of interest

Gen Li was partially supported by the AIS Investments AIGI CU15-2834. The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required. This article does not contain any studies with human participants performed by any of the authors, now does it contain any studies with animals performed by any of the authors.

Informed consent

No informed consent from the authors was required by any of the patients included in the analysis due to the de-identified nature of this population database analysis. IRB approval was obtained from Columbia University Medical Center.

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Benson, C.R., Thompson, S., Li, G. et al. Bladder and ureteral injuries during benign hysterectomy: an observational cohort analysis in New York State. World J Urol 38, 2049–2054 (2020). https://doi.org/10.1007/s00345-018-2541-y

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  • DOI: https://doi.org/10.1007/s00345-018-2541-y

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