Lower urinary tract injury during gynaecological and obstetric surgeries: Two years’ experience in our centre

Michael Lardas, Christos Papachristou, Emmanouil Chrysafis, Andreas Skolarikos

Abstract


Introduction: Operative injuries to the lower urinary tract during gynaecological and obstetric surgery are common due to its anatomic proximity with the reproductive system. The purpose of this article is to report our centre’s experience with these iatrogenic injuries over a period of 2 years.
Methods: We retrospectively reviewed our medical records during the years 2016 and 2017 in our department, to identify patients that were treated for lower urinary tract injury during or after gynaecological and obstetric surgeries.
Results: 11 females were treated in our hospital, with trauma to the bladder, or ureter following gynaecological or obstetric surgeries. The most common type of urinary tract injury was bladder injury, occurring in 8 patients followed by ureteric injury in 1 patient and bladder along with ureteric injury in 1 patient. One patient presented with right ureterovaginal fistula.
Conclusion: Bladder injury occurred very frequently as opposed to ureteral injury. The most significant risk factor for bladder injury during cesarean section seems to be previous cesarean delivery due to adhesive disease.


Keywords


urological trauma; lower urinary tract injury; bladder trauma; ureteric injury; iatrogenic injury

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References


Gilmour DT, Dwyer PL, Carey MP. Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy. Obstet Gynecol 1999; 94 (5 Pt 2): 8839.

Pal DK, Wats V, Ghosh B. Urologic complications following obstetrics and gynecologicai surgery: Our experience in a tertiary care hospital. Urol Ann. 2016; 8: 26-30.

Cordon BH, Fracchia JA, Armenakas NA. Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution. Urology. 2014; 84: 222-6.

Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol. 2018; 131: 100-8.

Lee JS, Choe JH, Lee HS, Seo JT. Urologic complications following obstetric and gynecologic surgery. Korean J Urol. 2012; 53: 795-9.

Ostrzenski A, Ostrzenska KM. Bladder injury during laparoscopic surgery. Obstet Gynecol Surv. 1998; 53: 175-180.

Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL. Risk factors for bladder injury during cesarean delivery. Obstet Gynecol 2005; 105: 156-60.

Klap J, Phe V, Chartier-Kastler E. Aetiology and management of iatrogenic injury of the ureter: a review. Prog Urol. 2012; 22(15): 913-9.

Brandes S, Coburn M, Armenakas N. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int. 2004; 94(3): 277-8.

Frankman EA, Wang L, Bunker CH, Lowder JL. Lower urinary tract injury in women in the United States, 19792006. Am J Obstet Gynecol 2010; 202: 495.e15.

Onuora VC, Al-Mohalhal S, Youssef AM, Patil M. Iatrogenic urogenital fistulae. Br J Urol 1993; 71: 176.




DOI: http://dx.doi.org/10.19264/hj.v30i1.225