Abstract
Objective:
The primary outcome of this study was to note the rate of delayed-diagnosis urinary tract injury posthysterectomy if ureteral catheters (UCs) were used to prevent such injuries.
Materials and Methods:
This cohort study, using the American College of Surgeons National Safety and Quality Improvement Project database, included women undergoing hysterectomy with or without UC placement. Demographic and outcome data were collected and compared.
Results:
The study involved 189,727 patients undergoing hysterectomies. The mean age of the entire cohort was 50.6 ± 12.9 (standard deviation [SD]) years and the mean body mass index was 31.4 ± 8.2 (SD). The rate of prophylactic UC placement was 0.58%. Women who underwent UC placement were more likely to have postoperative progressive renal insufficiency (0.54% versus 0.09%; p < 0.001) and postoperative urinary-tract infection (7.0% versus 2.5%; p < 0.001). There were 420 (0.22%) delayed-diagnosis urinary-tract injuries. The rate of any type of delayed-diagnosis urinary-tract injury was significantly higher in women who underwent UC placement (28, 2.5% versus 392; 0.21%; p < 0.001). Women with delayed-diagnosis urinary-tract injury had significantly more unplanned reoperations and readmissions. Multivariable logistic regression showed that the odds of having delayed-diagnosis urinary-tract injury were 9.54 times higher among patients who received UCs (confidence interval: 6.30–14.45; p < 0.001).
Conclusions:
UCs are rarely used during hysterectomy, tend to be utilized in cases when more difficulty is expected, and appear to increase, rather than decrease, the risk of urinary-tract injury. Routine use of prophylactic UCs during hysterectomies are not recommended. (J GYNECOL SURG 38:359)
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