Urinary Tract Injury During Benign Hysterectomy for Endometriosis: An NSQIP Study

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Surgical Quality Improvement

Background:

• Hysterectomy is a common gynecological procedure.
• Laparoscopic techniques and cystoscopy are widely adopted.
• Endometriosis is a known risk factor for surgical complications.

Purpose of the Study:

• To update the incidence of urinary tract injuries during hysterectomy.
• To assess the impact of laparoscopic surgery and cystoscopy on injury rates.
• To investigate the specific risk associated with endometriosis.

Main Methods:

• Retrospective cohort study using National Surgical Quality Improvement Program data (2018-2020).
• Analysis of 41,901 hysterectomies for benign indications in patients aged 18-55.
• Adjustment for prior pelvic surgery, laparoscopic route, and lysis of adhesions.

Main Results:

• Overall urinary tract injury rate was 1.0%-1.5%, with ureteral injury at 0.4%-0.8%.
• Laparoscopic hysterectomy showed a higher rate of ureteral injury (0.8%).
• Hysterectomy for endometriosis was associated with increased urinary tract injury (2.4%) and ureteral injury (1.8%).

Conclusions:

• Urinary tract injury rates in hysterectomy remain low.
• Laparoscopic approach and endometriosis are risk factors for urinary tract injury, particularly ureteral injuries.
• Early identification of injuries during the primary procedure is common.