Trends and Outcomes of Ureteral and Bladder Injury Intraoperatively Repaired During Open and Minimally Invasive Hysterectomy From 2013 to 2023: A National Matched Cohort Study.

STUDY

OBJECTIVE

Ureteral injury (UI) and bladder injury (BI) can occur during hysterectomy. Over the past 10 years, minimally invasive hysterectomies (MIHs) have become more common. We sought to compare the incidence of UI and BI during MIH and open hysterectomy (OH) and complications over the past 10 years.

DESIGN

A retrospective cohort study was conducted using the TriNetX research network.

SETTING

Large medical claims database of healthcare organizations in the United States.

PATIENTS: Patients older than 18 years who underwent MIH (laparoscopic or robot assisted) or OH from 2013 to 2023. Simultaneous pelvic exenterations, recurrent gynecologic tumor debulking, and previous UI or BI were excluded. Propensity score matching adjusted for differences in preoperative comorbidities. UI or BI was identified using International Classification of Diseases and Current Procedural Terminology codes.

INTERVENTIONS: MIH and OH.

MEASUREMENTS AND MAIN

RESULTS

A total of 211 637 patients underwent MIH whereas 54 705 underwent OH. The incidence of UI during MIH was 0.95% whereas the incidence of UI during OH was 0.57% (p <.01). UI in the MIH cohort increased over time (2013-2018, 0.76%; 2019-2023, 1.1%; p <.01). The highest incidence of UI was in 2023 (1.3%). The incidence of UI in OH did not change significantly. Patients who had UI were more likely to have infectious complications, readmissions, and ureteral strictures. BI in our MIH and OH cohorts was 0.24% and 0.81%, respectively (p <.01). Patients who had BI were more likely to have urinary tract infection, readmission, and vesicovaginal or ureterovaginal fistula. BI during MIH decreased from 2013 to 2018 (0.29%) to 2018 to 2023 (0.22%) (p <.01) but did not change for OH.

CONCLUSION

In our large national database study, we found that MIH patients were more likely to have UI but less likely to have BI than OH patients. The incidence of UI during MIH is increasing with time. The short- and long-term sequela are significant with increased rates of readmission, infections, ureteral strictures, and fistulas.