Routine cystoscopy after minimally invasive hysterectomy associated with increased UTIs

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A study to evaluate incidence of urinary tract infection (UTI) post-robotic-assisted hysterectomy and routine cystoscopy demonstrated a higher rate of UTI in younger patients with increased estimated blood loss (EBL) who underwent longer, more complex surgeries. Further, these patients were also noted to have a higher incidence of a malignant post-operative diagnosis. 

The results were presented at the 2019 American Association of Gynecologic Laparoscopists (AAGL) Congress in Vancouver by Katherine Kleinberg, a medical student from Burrell College of Osteopathic Medicine, Las Cruces, NM. Ms. Kleinberg was invited by the AAGL Scientific Committee to present her study findings at the Congress.

“The objectives of this study were to evaluate incidence of UTI status post-robotic-assisted hysterectomy and routine cystoscopy, to compare instances from malignant and benign surgical cases, and justify routine cystoscopy in robotic assisted hysterectomy,” Ms. Kleinberg stated.

Methods
The 151 cases that made up this study were obtained from the database of a single gynecologic oncologist. In these cases, minimally invasive robotic total hysterectomy was performed for treatment of both benign and malignant disease, and patients who did not meet the standard of minimally invasive surgery were excluded. In all cases, routine cystoscopy was performed to detect any intraoperative injury to the ureters and bladder. No detectable urinary tract injury was reported in any of these patients.

Findings
In those cases where routine cystoscopy was performed, dysuria was the most common urinary tract complaint in postoperative clinic visits. Postoperative UTIs were found in 21 (13.9%) of patients within 30 days of the procedure, with 2% to 9% of benign cases and 4% to 31% of malignant cases presenting with UTI. Patients with postoperative UTIs were noted to have had longer operating room times, more complex surgeries, higher estimated blood loss, and were younger. The only statistically significant variable reported between the malignant and benign cohorts was presence of postoperative complications, with incision cellulitis being the most common complication seen in patients with malignant disease.

Conclusions
The results demonstrate that, although UTIs are common in women undergoing gynecologic surgery, rates of infection appeared to be higher in this cohort composed of patients in whom routine cystoscopy was performed. Ms. Kleinberg noted that a similar study consisting of a larger sample size should be considered.