Urological Injuries during Obstetric and Gynecological Surgical Procedures: Two Centers Experience
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- Category: Vol. 79, June 2011
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Urological Injuries during Obstetric and Gynecological Surgical Procedures: Two Centers Experience,TAREK R. ABBAS and MAHMOUD M. OSMAN
Abstract
Objective: To retrospectively analyze the frequency and outcome of urological injuries in obstetric and gynecological surgical procedures in two medical centers.
Patients and Methods: This retrospective study done for a total of 4710 patients, who underwent cesarean section (3870) and hysterectomy (840) operations in two centers (Al-Hussein University Hospital and Assiut University Hospital during time interval from January 2006 - March 2010. Detailed history and physical examination, and the investigations of the patients were carried out. Patients were operated by a senior surgeon, and those that suffered urological injury were analyzed. The nature of injury, the timing of diagnosis and methods of repair all were recorded.
Results: During the study period 840 patients had under-went hysterectomy and 3870 patients underwent cesarean section (total 4710 patients). Urological injuries recorded in 46 (0.98%) patients. Sustained bladder injury was reported in 14 (1.7%) and 16 (0.41%) cases who underwent hysterec-tomy and caesarean section, respectively. All bladder injuries except one case diagnosed intraoperatively.
Ureteric injury was seen in ten (1.19%) hysterectomy and six (0.15%) caesarean section patients; the injuries included ligation in 8 (0.16%) cases, transaction in 4 (0.08%), ligation and transaction in 3 (0.06%), and ureterovaginal fistula in 1 (0.02%) case. Intraoperative diagnosis of injuries was made in 5 (31.2%) and postoperative in 11 (68.8%) patients. Cases of bladder injury were treated by formal surgical repair and bladder drainage, while patients with ureteric injury were treated by surgical repair and/or ureteral stenting.
Conclusion: Urological injuries though uncommon, yet add significant contribution to morbidity. To reduce the morbidity from urological injuries in obstetric and gyneco-logical procedures, careful preoperative workup, and in difficult cases anticipation and suspicion of the injury is essential.