Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Mar 20, 2023; 13(2): 18-25
Published online Mar 20, 2023. doi: 10.5662/wjm.v13.i2.18
Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter?
Emilee Khair, Fareeza Afzal, Sanjana Kulkarni, Beaux Duhe', Karen Hagglund, Muhammad Faisal Aslam
Emilee Khair, Fareeza Afzal, Sanjana Kulkarni, Muhammad Faisal Aslam, Department of Obstetrics and Gynecology, Ascension St John, Detroit, MI 48236, United States
Beaux Duhe', Department of Obstetrics and Gynecology, St. George's University School of Medicine, Great River, NY 11739, United States
Karen Hagglund, Department of Medical Research, Ascension St John, Detroit, MI 48236, United States
Author contributions: Khair EL designed the study, collected data, and wrote and edited the manuscript; Afzal F, Kulkarni SP, and Duhe’ BJ collected data for the manuscript; Hagglund K analyzed the data for the manuscript; Aslam MF edited the manuscript and assisted in study design; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer. IRB Reference number: 1820585.
Informed consent statement: The study is a retrospective study and therefore informed consent was not obtained, as it was exempt by the IRB.
Conflict-of-interest statement: We have no conflicts of interest to disclose and there has been no financial support for this research that could have influenced the outcome. As the corresponding author, I confirm that the manuscript has been reviewed and approved for submission by all authors.
Data sharing statement: Statistical code and dataset are available from Emilee Khair, MD at Consent was not obtained but the presented data are anonymous and risk of identification was low.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Emilee Khair, MD, Doctor, Department of Obstetrics and Gynecology, Ascension St John, 22101 Moross Rd, Detroit, MI 48236, United States.
Received: October 30, 2022
Peer-review started: October 30, 2022
First decision: January 20, 2023
Revised: February 2, 2023
Accepted: February 13, 2023
Article in press: February 13, 2023
Published online: March 20, 2023

Ureteral injury is a known complication of hysterectomies. Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies. Some studies have reported that as surgeon volume increases, urinary tract injury rates decrease. To our knowledge, no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy.


To determine the incidence of urinary tract injury between urogynecologists, gynecologic oncologists, and general gynecologists.


The study took place from January 1, 2016 to December 1, 2021 at a large community hospital in Detroit, Michigan. We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon’s volume per year was calculated. Patient demographics, medical history, physician-dictated operative reports, and all hospital visits postoperatively were reviewed.


Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group excluding urinary tract, bowel, or major vessel injury. High-volume surgeons had four (1%) patients with a complication and low-volume surgeons had 12 (4%) patients with a complication (P = 0.04).


Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists, however our study was underpowered.

Keywords: Minimally invasive hysterectomy, Urinary tract injury, Surgeon volume, High volume gynecologist, Low volume gynecologist

Core Tip: Surgeon volume and experience have been shown to play a role in decreasing the number of urinary tract injuries during minimally invasive hysterectomies. One may conclude that since urogynecologists and gynecologic oncologists had additional training years after residency, they also have more experience. This may result in a decreased incidence of urinary tract injury during minimally invasive hysterectomies. To our knowledge, no studies to date have been done to assess this correlation.