Is Routine Cystoscopy Warranted After Robotic Hysterectomy?

Abstract

INTRODUCTION: With mixed results, authors have attempted to determine if routine cystoscopy is warranted after hysterectomy. Some authors suggest that routine cystoscopy is warranted, whereas others suggest that cystoscopy should only be used after difficult hysterectomy or if the surgeon has a low case volume. No studies have exclusively examined cystoscopy after robotic hysterectomy. Based on mixed conclusions from prior studies with numerous routes of hysterectomy, we set out to determine if routine cystoscopy after robotic hysterectomy is warranted. METHODS: This is a retrospective study; we collected data on patients who underwent robotic hysterectomy for benign and malignant indications from October 2007 to April 2011. Exclusion criteria were robotic hysterectomy without cystoscopy and hysterectomy performed without robotic assistance. RESULTS: Two hundred thirty-two patients underwent robotic hysterectomy during the study period. Seven patients did not undergo cystoscopy and were excluded. In the study population, the incidence of ureteral injury was 1.7%; there were no bladder injuries. Five cystoscopies were abnormal; three of these were falsely positive. In the false-positives, stents were placed and no injury identified. Two patients had normal cystoscopy but later presented to the emergency department with ureteral injury. Routine cystoscopy showed: sensitivity 50.0%, specificity 98.6%, positive predictive value 40.0%, and negative predictive value 99.0%. CONCLUSION: As a result of poor sensitivity and poor positive predictive value, we believe that cystoscopy should not be routinely performed after robotic hysterectomy. Both routine cystoscopy and unnecessary intervention for false-positive cystoscopy increase the cost of robotic hysterectomy.