Risk factors for ureteral obstruction and the diagnostic value of the 'cysto-under-tension' technique at the time of uterosacral colpopexy
| Autor: | Surabhi Tewari, Olivia H. Chang, Cecile A. Ferrando, Jinger Y. Sun |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
030219 obstetrics & reproductive medicine medicine.diagnostic_test urogenital system business.industry Urology Incidence (epidemiology) Uterosacral ligament 030232 urology & nephrology Obstetrics and Gynecology Cystoscopy urologic and male genital diseases Logistic regression Vaginal cuff female genital diseases and pregnancy complications Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Ureteral injury medicine Ureteral Obstructions Adverse effect business |
| Zdroj: | International Urogynecology Journal. 32:2985-2992 |
| ISSN: | 1433-3023 0937-3462 |
| DOI: | 10.1007/s00192-020-04650-5 |
| Popis: | The objective is to determine the incidence of ureteral obstruction and delayed ureteral injury and to identify risk factors for ureteral obstruction following uterosacral colpopexy. The secondary objective is to evaluate the diagnostic value of the “cysto-under-tension” technique, when a cystoscopy is performed prior to vaginal cuff closure with the uterosacral sutures on tension. This was a retrospective review of patients undergoing uterosacral ligament colpopexy between 2007 and 2012 with a nested case-control analysis. Patients with documented ureteral obstruction on cystoscopy or a delayed ureteral injury were identified. Cases were defined as patients with a ureteral obstruction on cystoscopy and controls as those who did not; a multivariable regression analysis was performed. A total of 551 patients underwent uterosacral ligament colpopexy. Twenty-four (4.3% [95% CI = 2.94–6.40]) patients had a ureteral obstruction on cystoscopy, and two (0.4% [95% CI = 0.09–1.31]) patients experienced a delayed ureteral injury. The “cysto-under-tension” technique was used in 40 (7.3%) cases, with a sensitivity of 50.0% (CI = 1.26–98.74) and specificity of 97.4% (CI = 86.2–99.9) to detect ureteral obstruction. On logistic regression for the case-control analysis, increased age remained associated with increased odds of ureteral obstruction (adjOR 1.06, 95% CI = 1.02–1.11) and a higher BMI had lower odds (adjOR 0.89, 95% CI = 0.79–0.98). In this large cohort study, older age was associated with higher odds of obstruction at the time of colpopexy while a higher BMI might have been protective. The “cysto-under-tension” technique overall may not be that useful in detecting ureteral obstructions but has high negative predictive value. |
| Databáze: | OpenAIRE |
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