Background: Iatrogenic bladder injuries (IBI) are more common during obstetric and gynaecological procedures averaging 2.6 IBIs per 1000 surgeries. The objective of the study was to estimate the incidence of IBIs during OBG procedures in a tertiary care hospital at Puducherry. To study the proportion and clinical profile of the IBIs where the management of an urologist was indicated intra-operatively.Methods: This cross-sectional study was conducted in a tertiary care hospital in Puducherry by analysis of records of OBG surgeries conducted during the 5 years’ period from 2011 to 2015. The occurrence of IBIs during obstetric and gynaecological surgeries was estimated and the records of those with injuries were analysed retrospectively.Results: The overall incidence of Iatrogenic Bladder Injuries (IBI) among the OBG surgeries was 1.33% (n=19). Iatrogenic Bladder Injuries (IBI) frequently happened during Gynaecological procedures (73.7%, n=14) than during Obstetric procedures (26.3%, n=5). The incidence of bladder injuries intra-operatively was more frequent during dissection of bladder (57.9%, n=11) and opening the abdomen (36.8%, n=7). The requirement of urologist was more felt during posterior bladder wall injuries (26.3%, n=5).Conclusions: The occurrence of IBIs was more common during Gynaecological procedures than during obstetric procedures. Most of the gynaecological procedures especially hysterectomies require the expertise presence of an urologist.

BACKGROUND:Ureteric injury is one of the most serious complications in abdominal and vaginal hysterectomies. It leads to significant morbidity due to ureterovaginal fistulas and potential loss of kidney function. Aim of this study is to evaluate how and why ureteric injuries occur during hysterectomy and to highlight the outcome with appropriate surgical treatment. METHODS AND MATERIALS: This prospective and observational study was carried out at the Department of Obstetrics & Gynaecology and Urology, from March 2014 to May 2015. Total numbers of hysterectomies done were 246 that include 144 total abdominal hysterectomies, 61 vaginal hysterectomies and 41 laparoscope assisted vaginal hysterectomy (LAVH). All ureteric injury patients were analysed for incidence, location, type of injury, recognition time and management. RESULTS: Incidence of ureteric injury in our study is 0.8%. Types of ureteric injuries were ureteric transection, suture ligation, uretero-vaginal fistula and thermal injury due to surgical diathermy. Interval between surgery and diagnosis of injury varies between immediate during surgery and 2 days to 4weeks of postoperative period. All the patients had lower ureteric injuries. Bilateral ureteral involvement was seen in one patient and 8 patients had unilateral ureter involvement. Left ureter was involved in all the cases of LAVH. Contrast enhanced CT scan were done for confirmation of ureteric injuries. Psoas hitch with ureteroneocystostomy done in 7 patients, for a patient with ureteric stricture, Double J Stenting followed by ureteral reimplantation with psoas hitch was done after one year. Bivalveing of bladder, Boari flap with ureteral reimplantation and psoas hitch was carried out in one patient who had associated vesico-vaginal fistula (VVF) with ureteric injury. All the patients were symptom free and with no evidence of obstruction. CONCLUSION: Iatrogenic ureteric injuries are preventable. Timely recognition and intervention has good outcome.