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Universal Cystoscopy? LSUHealthNO OB/GYN Chair Weighs In

Dr. Lisa Peacock at ACOG Session

Dr. Lisa Peacock, Obstetrics & Gynecology chair and director of female pelvic medicine and reconstructive surgery at LSU Health New Orleans School of Medicine, took the pro position in a debate about whether or not obstetricians should routinely check the bladder and urethra when performing hysterectomies. The debate comprised the John I. Brewer Memorial Lecture at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists this month. She shared research results including the largest multi-center study looking at the question. That study found the detection rate of injury to the urethra and bladder of 6.7% and 37.5%, respectively, jumped to 97.4% overall with cystoscopy. A cystoscopy is a procedure to examine the lining of the bladder and urethra using a hollow tube with a lens called a cystoscope.

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"The proponents against universal cystoscopy would say that you are going to give them UTIs (urinary tract infections), bladder and ureteral trauma, and they're going to react to our contrast agent, but I will tell you that after the five major studies that I've pulled that represent 5,283 patients, there was one complication,” Dr. Peacock said. "The one complication was one you wouldn't even think to occur. That institution had bought a new warming unit and they put their fluid in there, and it was too hot and they scalded the bladder."

Even though support has been growing for the better safe than sorry approach, both sides stressed the need for more research and cost analysis.

'We still need more research and cost analysis,” concludes Peacock. "The cost analysis we've been working on is 16 years old. It had significant limitations that could have impacted the threshold rate and it may actually be lower. We need better prospective studies to really determine our injury rates. We need to look at how we can reduce costs. This could be an effective way to detect injury at a cost price point where it's not egregious."

Dr. Lisa Peacock
According to the American College of Obstetricians and Gynecologists, the College, founded in 1951, is the specialty's premier professional membership organization dedicated to the improvement of women's health. With more than 58,000 members, the College is a 501(c)(3) organization and its activities include producing the College's practice guidelines and other educational material.