OBJECTIVES : Iatrogenic lower urinary tract injury (LUT) is an uncommon but potentially morbid complication of pelvic surgery. An unrecognized LUT can lead to significant consequences, including abscess, ureteral stricture, and potential loss of ipsilateral kidney or even death. This study was to characterize the 90-day complications associated with LUT and assess the impact of recognized vs unrecognized LUT.

METHODS : Patients who underwent hysterectomy for benign conditions from January 1, 2013 to December 31, 2019 were identified in Premier Healthcare Database®. LUT was categorized as recognized if diagnosed/repaired on the day of hysterectomy and unrecognized if diagnosed/repaired . We examined LUT rates by surgical approach and assessed impact of LUT on 90-day clinical outcomes including hospital readmission, nephrostomy tube placement, acute renal failure, and sepsis as well as perioperative 90-day cost. The independent effect of recognized and unrecognized LUT on occurrence of aforementioned outcomes was evaluated using multivariate regression analysis.

RESULTS : LUT was reported in 0.29% of the 705,557 benign hysterectomy patients and 69.1% of LUT was unrecognized. Open hysterectomy had highest LUT (0.5% in 150,623), followed by laparoscopic hysterectomy (0.24% in 236,081) and robotic-assisted hysterectomy (0.23% in 236,349), whereas vaginal hysterectomy had the lowest risk (0.16% in 82,504). Higher 90-day readmission was observed among those with recognized (14.5%) and unrecognized LUT (67.3%) compared to those without. Nephrostomy tubes were required in 9.8% of the recognized and 36.9% of the unrecognized LUT patients. Recognized and unrecognized LUT patients had 1.9- and 3.1-fold increase in total postoperative costs compared to patients without LUT, respectively. Recognized and unrecognized LUT independently increased risk of sepsis (Adj-OR 3.0 95% CI [2.1-4.1] and 16.3[12.8-20.5]) and renal failure (6.4 [4.8-8.9] and 21.3 [19.1.2-29.5]).

CONCLUSIONS : Unrecognized LUT drastically increased the risk of hospital readmission and potential life threatening complications, implicating that every effort should be made to detect LUT intraoperatively.