Barriers to Universal Cystoscopy After Hysterectomy

Abstract

Abstract

Objective:

The goal of this study was to identify logistical reasons that preclude the adoption of universal cystoscopy after hysterectomy among practicing gynecologic surgeons at an academic teaching institution.

Materials and Methods:

A mixed methods study was created, using a cross-sectional questionnaire and focus groups. A 10-item questionnaire was utilized regarding attitudes associated with universal cystoscopy, demographics, prior cystoscopy training, and surgical volume. The questionnaire was distributed to departmental general gynecologic surgeons who teach hysterectomy at 2 clinical sites (a private hospital and a safety-net hospital). Questions were developed from the results to guide sessions of focus groups; these sessions were conducted to uncover themes. Qualitative-analysis software was used to refine an analysis of theme occurrences. A third-party faculty member reviewed and created themes from the transcribed data. Assessments were made of results obtained from these sources.

Results:

Three main themes concerning logistical barriers to the use of universal cystoscopy after hysterectomy were identified: (1) perceived cost; (2) adequacy of training; and (3) the ability to teach the skill to residents.

Conclusions:

General gynecologic surgeons at U.S. teaching hospitals do not use universal cystoscopy after hysterectomy due to cost concerns, and inadequate training that hinders troubleshooting and lessens resident teaching of the skill.