Published: 2022-08-29

Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist

Vineet V. Mishra, Smit B. Solanki, Rohina Aggarwal, Sumesh Choudhary, Kunur Shah, M. Anusha


Background: The goal of this study is to find out: how important it is to utilize intraoperative cystoscopy liberally in normal gynaecological procedures to detect urinary tract injuries, how long it takes to do intraoperative cystoscopy and what problems are linked with cystoscopy.

Materials: The study is from the year 2016 to 2022 involving around 1221 patients. In a tertiary care facility, retrospective observational research was conducted. The study comprised patients receiving all gynaecological and urogynaecological operations. Malignancy was ruled out. Following gynaecological surgery, a 20-F-30-degree telescope was used to perform a cystourethroscopy. To record case information, a study proforma was created.

Results: Intraoperative cystoscopy detected four bladder injuries during anti-incontinence surgery (TVT) and hysterectomy. After a thorough laparoscopic hysterectomy with normal cystoscopy, one patient returned one month later with right ureteric injury. A urinary tract infection struck fifteen people shortly after surgery. After surgery, one patient suffered flank pain and a fever for 48 hours. There was no sign of urinary tract injury on a CT-IVP scan. She was handled with care.

Conclusions: For early diagnosis of urinary tract injuries, gynaecologists should have a low threshold for performing intraoperative cystoscopy during gynaecological procedures. Early detection and treatment of urinary tract injuries reduces the patient's morbidity, with a successful repair outcome at the time of detection. Performing an intraoperative cystoscopy during gynaecological procedures allows for this.


Urinary tract injuries, Intraoperative cystoscopy, Gynaecological operations

Full Text:



Smith AP, Bazinet A, Liberman D. Iatrogenic ureteral injury after gynecological surgery. Can Urol Assoc J. 2019;13(4):S51-5.

Barber EL, Polan RM, Strohl AE, Siedhoff MT, Clarke-Pearson DL. Cystoscopy at the time of hysterectomy for benign indications and delayed lower genitourinary tract injury. Obstet Gynecol. 2019;133(5):888-95

Ridha F, Latifa M, Ines R, Maamar H, Salem B. Ureteral injuries complicating gynecologic surgery. Pan Afr Med J. 2018;30:145

AAGL advancing minimally invasive gynecology worldwide. AAGL practice report: practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy. J Minim Invasive Gynecol. 2012;19: 407

Simms KT, Yuill S, Killen J, Smith MA, Kulasingam S, de Kok IMCM, et al. Historical and projected hysterectomy rates in the USA: Implications for future observed cervical cancer rates and evaluating prevention interventions. Gynecol Oncol. 2020; 158(3):710-8.

Singh A, Arora AK. Why hysterectomy rate are lower in India?. Indian J Commu Med. 2008;33(3):196-7.

Desai S, Sinha T, Mahal A. Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India. Reprod Health Matters. 2011;19(37):42-51.

Chi AM, Curran DS, Morgan DM, Fenner DE, Swenson CW. Universal cystoscopy after benign hysterectomy: examining the effects of an institutional policy. Obstet Gynecol. 2016;127(2): 369-75.

Mensah J, Klufio G, Ahiaku F, Osafo C, Gepi-Attee S. Delayed recognition of bilateral ureteral injury after gyneacological surgery. Ghana Med J. 2008; 42(4):133-6

Kumar S, Vatsa R, Bharti J, Roy KK. Urinary fistula-A continuing problem with changing trends. J Turkish German Gynecol Assoc. 2017;18(1):15-9.

Sharma S, Rizvi SJ, Bethur SS, Bansal J, Qadri SJF, Modi P. Laparoscopic repair of urogenital fistulae: A single centre experience. J Minimal Access Surg. 2014;10(4):180-4.

Teeluckdharry B, Gilmour D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy: a systematic review and meta-analysis. Obstet Gynecol. 2015;126:1161-9.

Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol. 2006;107: 1366-72.

Ibeanu OA, Chesson RR, Echols KT, Nieves M, Busangu F, Nolan TE. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol. 2009;113:6-10

Kaestner L. Management of urological injury at the time of urogynaecology surgery. Best Pract Res Clin Obstet Gynaecol. 2019;54:2-11.

Fischer JR. Just do it!: routine cystoscopy should be done at the time of gynecologic surgery. Obstet Gynecol. 2015;126(6):1136-7.

Luchristt D, Geynisman-Tan J, Mueller MG, Kenton K. Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy. J Minim Invasive Gynecol. 2021; 28(8):1470-83.

ACOG Committee. The role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol. 2007;110:221-4.

Chi AM, Curran DS, Morgan DM, Fenner DE, Swenson CW. Universal cystoscopy after benign hysterectomy: examining the effects of an institutional policy. Obstet Gynecol. 2016;127(2): 369-75.

Farrell SA, Baskett TF, Baydock S. The use of intraoperative cystoscopy by general gynaecologists in Canada. J Obstet Gynaecol Can. 2009;31:48-53

Mahmoudi A, Noomen F, Nasr M, Zouari K, Hamdi A. Evaluation of residency training in general and digestive surgery in Tunisia. Pan Afr Med J. 2015; 21:328.