Risk Factors for Urologic Injury in Women Undergoing Hysterectomy for Benign Indication

Nayak AL, Ameeta L. Nayak, Ameeta Lubina Nayak, Rodney H. Breau, Breau R, Rodney Breau, Hickling D, Duane Hickling, Pascali D, Dante Pascali, Aisling A. Clancy, Aisling Clancy, Ranjeeta Mallick, Mallick R, Innie Chen
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2021 · vol. 44(3) , pp. 247–254 · doi:10.1016/j.jogc.2021.09.020 · PMID:34648958 · W3024484815
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-11 ⓘ

This study identified surgical duration, larger uterine size, and previous pelvic surgery as risk factors associated with urologic injury in women undergoing hysterectomy for benign indications.

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Abstract

ObjectiveTo investigate risk factors associated with urologic injury in women undergoing hysterectomy for benign indication.MethodsA retrospective cohort study for the period of 2011-2018 was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Women without urologic injury were compared with women with injury. A pre-specified multivariable logistic regression model, controlling for key patient demographic factors and intraoperative variables, was used to assess for surgical factors associated with urologic injury.ResultsAmong 262 117 women who underwent hysterectomy for benign indication, 1539 (0.6%) sustained urologic injury. On average, patients with urologic injury were younger, had lower body mass index (BMI), and more frequently underwent a transabdominal surgical approach. Patients who underwent total hysterectomy had increased odds of urologic injury than those who underwent subtotal hysterectomy (adjusted OR [aOR] 1.49; 95% confidence interval [CI] 1.21-1.84). Patients with class III obesity had lower odds of injury than patients with normal BMI (aOR 0.64; 95% CI 0.51-0.80). For risk of urologic injury, an interaction was observed between surgical approach and surgical indication. Abdominal compared with laparoscopic approach was associated with urologic injury for women with endometriosis (aOR 2.98; 95% CI 1.99-4.47), pelvic pain (aOR 3.51; 95% CI 1.74-7.08), menstrual disorders (aOR 4.33; 95% CI 1.68-11.1), and fibroids (aOR 2.28; 95% CI 1.72-3.03). Vaginal compared with laparoscopic approach was associated with increased odds of injury for women with menstrual disorders (aOR 7.62; 95% CI 1.37-42.5).ConclusionWhile the risk of urologic injury during hysterectomy for benign indication is low, the risk is dependent on patient disease factors and surgical approach.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Laparoscopy Body Mass Index Female Humans Hysterectomy Hysterectomy Postoperative Complications Postoperative Complications Retrospective Studies Risk Factors

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