The value of cystoscopy in major vaginal surgery

This article reviews the case histories of 236 patients who had cystoscopy as part of their major vaginal operations. Seven had cystoscopically detected potential lower urinary tract injuries. Five of these injuries were ureteral obstructions, one occurring after anterior repair, three associated with a McCall culdoplasty, and one associated with a modified Pereyra bladder neck suspension. Two injuries were subtle cystotomies. These compromises of the lower urinary tract were detected during the main operative procedure and immediately rectified. We propose that routine intraoperative cystoscopy associated with intravenous administration of indigo carmine is an excellent method for detecting actual and potential lower urinary tract surgical injury. Cystoscopy cannot distinguish which surgical distortion or injury will spontaneously resolve. The identification of non-blood-tinged urine from both ureteral orifices and the absence of bladder trauma should eliminate the possibility of lower urinary tract surgical injury, except for ischemic necrosis. Cystoscopy, like laparoscopy, is a procedure that should benefit our patients and should not isolate a specialty.