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Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Revisiting Urological Injury Risks in Minimally Invasive Hysterectomy for Benign Indications: A Rare-Events Network

Chiara Cassani1,2, Arsenio Spinillo3,4, Mattia Dominoni4

  • 1Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy. chiara.cassani@unipv.it.

International Urogynecology Journal
|March 26, 2026
PubMed
Summary

Total laparoscopic hysterectomy (LH) and laparoscopically assisted vaginal hysterectomy (LAVH) increase the risk of bladder and ureteral injuries compared to abdominal hysterectomy (AH). This elevated risk persists, indicating no improvement with wider adoption of laparoscopic techniques.

Keywords:
Bladder injuriesHysterectomyIntraoperative complicationsLaparoscopic hysterectomyNetwork meta-analysisUreteral injuries

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Area of Science:

  • Gynecology
  • Surgical Oncology
  • Urology

Background:

  • The surgical approach in hysterectomy impacts urological injury risk.
  • Optimal technique for minimizing these risks is not well-defined.

Purpose of the Study:

  • To evaluate the risk of intraoperative bladder and ureteral injuries across different hysterectomy techniques.
  • Utilized a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Main Methods:

  • Systematic search of multiple databases (Cochrane, MEDLINE, Embase, etc.) up to January 2025.
  • Network meta-analysis and pairwise meta-analyses using penalized logistic regression and Bayesian models.
  • Accounting for rare events in statistical analysis.

Main Results:

  • Included 63 RCTs with 7470 women; reported 69 bladder, 23 ureteral, and 96 combined injuries.
  • Total laparoscopic hysterectomy (LH) and LH/laparoscopically assisted vaginal hysterectomy (LAVH) showed significantly higher ureteral injury risk than abdominal hysterectomy (AH).
  • LH and LH/LAVH carried a higher risk of any urological injury compared to AH, with elevated risks persisting over time.

Conclusions:

  • Laparoscopic hysterectomy and LH/LAVH are linked to increased ureteral and bladder injury rates versus AH.
  • The persistent elevated risk suggests that standardization and adoption of LH have not reduced urological complications.
  • Highlights the need for improved surgical strategies to mitigate urological injuries during hysterectomy.