Systematic review of urological injury during caesarean section and hysterectomy

Wei, Gavin; Harley, Frances; O’Callaghan, Michael; Adshead, James; Hennessey, Derek; Kinnear, Ned

doi:10.1007/s00192-022-05339-7

Cited by 11 publications

(13 citation statements)

References 121 publications

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“…And the rate of blood transfusion was higher on patients had severe anaemia particularly on haemoglobin less than 9.5 g/dl which had significant risks as reported by Ehrenthal, et al study (2012) [13]. In recent systematic review (2022) had reported that the overall total numbers of relevant study were 312 bladder injures and 7 ureteric injuries with mean injury rates documented were 267 and 9 events per 100,000 cases respectively [14]. And most of these injuries occurs secondary to caesarean section and hysterectomy [15][16][17].…”

Section: Bowel Injury 0mentioning

confidence: 87%

Comparison Between Elective Versus Emergency Caesarean Section on Intra Operative Surgical Findings and Feto Maternal Outcomes

2023

Gynecol Obstet Open Acc

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Background:The cesarean section is one of the most common operative procedures throughout the world with global rate increasing both developed and developing countries. Objective: To compare and evaluate the intraoperative surgical findings on elective versus emergency caesarean section and fetomaternal outcomes. Methods and materials: This study was descriptive comparative carried out at obstetrics and gynecology department of Tripoli university hospital during 1st January to 31th March 2023. The selected sample included 130 pregnant women which divided into two groups (65 patients had delivered by elective CS and another 65 patients had delivered by emergency CS). The collected data was entered, coded and analyzed by using SPSS version 25. The P value of less than 0.05 was considered as statistically significant. Results: We studied 130 pregnant women who's evaluated and compared the feto maternal outcomes on elective verses emergency caesarean section aged between 21 to 48 years, the mean maternal age among elective CS was 33.46 ± 4.169 SD and the mean maternal age among emergency CS was 32.03 ± 5.598 SD. The main indication of CS had reported was previous caesarean section both for elective and emergency caesarean delivery which accounts (41/63.1%) and (15/23.1%) respectively with highly statistically significant results reported (P -value = 0.000). And on compare the intraoperative surgical findings, the rate of adhesion more prevalent on elective CS while the rate of bleeding was more frequently on emergency CS with statistically significant results (P -value = 0.001 and 0.011) respectively. Although, most of patients (83.1%) did not expressed intra operative complications but 6.9% (9) had hysterectomy (6 of 9 on emergency CS while 3 of 9 on elective CS) and 3.8% (5) had expressed urinary tract injury (3 of 5 on emergency CS while 2 of 5 on elective CS). And 19.2% (25) of neonates had admitted to neonatal intensive care unit which represented 15.3% (20) of them had delivered by emergency CS while 3.9% (5) of them had delivered by elective CS with statistically significant results (P-value=0.001). Conclusion: On summary, the raising rate of caesarean section either by elective or emergency manner had significant adverse impacts on feto maternal outcomes with high rate of maternal bleeding, adhesion, abnormal placentation and overall increase risk of neonatal and maternal intensive care unit admission. Therefore, optimal perinatal assessment throughout pregnancy period is essential to reduce rate of unnecessary caesarean section and minimize related morbidity and mortality of caesarean delivery particularly emergency type.

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Section: Bowel Injury 0mentioning

confidence: 87%

Comparison Between Elective Versus Emergency Caesarean Section on Intra Operative Surgical Findings and Feto Maternal Outcomes

2023

Gynecol Obstet Open Acc

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“…again, probably due to the overconfidence factor [19]. On the other hand, the use of cystoscopy to detect urinary tract lesions is not completely standardized; There are reports where, despite the existence of blad-der or ureteral lesions, cystoscopy has failed to diagnose them [20]. It is reported that the detection rate is low (1.6 per 1000 surgeries) with the routine use of cystoscopy and 0.7 without the use of cystoscopy; Cystoscopy is not so harmless because its complications include bleeding or injury to the ureter per se, so the risk-benefit of performing it routinely must be assessed; However, there is the other side of the coin, detect it in time [21].…”

Section: Discussionmentioning

confidence: 99%

"Urological Surgical Injuries in Gynecology and Obstetrics. 10-Year Review"

Prior-Rosas

2024

BJSTR

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Introduction: Urinary tract injuries are rare but when presented are among the most serious complications of pelvic surgery it can cause significant morbidity for the patient and is a leading cause of litigation in many countries. The incidence in low resource settings is not well documented.Objective: Determinate the prevalence of urinary tract injury, associated with gynecologic and obstetric surgery. Methods:A descriptive and ambispective analytical study was carried out to determine the prevalence of urinary tract injury, associated with gynecological and obstetric surgery, it was diagnosticated intraoperatory or during the postoperative. The results were analyzed with the statistical program SPSS-27.0. Results:During the period from 2013 to 2023, a total of 27 injuries to the urinary tract occurred, of which 19 were to the bladder (73.07%), 6 ureteral injuries (22%) and 2 injuries that involved both the bladder and ureters (7.69%). Bladder injuries in cases of abdominal hysterectomies were 3.08% (21/680), and ureteral injuries were 1.17% (8/680). Conclusion:The precaution and knowledge of anatomy is of utmost importance to minimize the risk of these structures; early recognition and their repair has a positive prognosis in the morbidity of patients.

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“…They did not find any other predictors regarding previous surgery, previous radiation, diagnosis, type of surgery or demographics. Wei et al 8 found that surgeon inexperience was the main prime risk for these injuries, and Ali et al 6 found that late diagnosis of IUIs were more common amongst non-specialist surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…The reason why younger age and benign indication for hysterectomy predispose for a delayed diagnosis is not clear to us, but one theory that already has been mentioned is surgeon experience 6 , 8 . Our theory is that the more experienced surgeons perform surgery on malignant indication, due to the importance of radical tumour resection.…”

Section: Discussionmentioning

confidence: 99%

A delayed diagnosis of iatrogenic ureteral injury results in increased morbidity

Maheswaran,

Beisland,

Bergesen

et al. 2024

Sci Rep

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This study aimed to register and analyse outcomes after iatrogenic ureteral injuries (IUI) with special emphasis on potential consequences of a delayed diagnosis, and further to analyse if the incidence of IUI has changed during the study period. 108 patients treated for an IUI during 2001–2021 were included. Injuries due to endourological procedures, planned tumour resection and traumatic injuries were excluded. All relevant information to answer the research questions were entered into a database. Chi-square and t-tests were used for categorical and continuous variables respectively. Regression analysis was used to evaluate potential change of incidence in IUIs over time. Our results showed that most IUIs (74, 69%) were caused by gynaecological surgery. 49 (45%) had a delayed diagnosis (not diagnosed intraoperatively). Younger age (mean 50 vs 62 years, p < 0.001) and benign indication for laparoscopic hysterectomy (OR 8.0, p < 0.001) predisposed for a delayed diagnosis. Patients with a delayed diagnosis had a higher number of secondary injury related procedures (mean 4.6 vs 1.7, p < 0.001), hospital admissions (mean 3.0 vs 0.8, p < 0.001) and longer hospital stays (mean 20.6 vs 3.9 days p < 0.001) compared to patients with an intraoperative diagnosis. There was complete recovery for 91% of the patients. We did not observe any changes in IUI incidence during the study period. In conclusion, our study underlines that IUI can cause major morbidity for the patient affected if not diagnosed intraoperatively. Benign indication and younger age are predictors for a delayed diagnosis. The prognosis is good, with 91% full recovery. No significant changes in incidence of IUIs were observed.

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Systematic review of urological injury during caesarean section and hysterectomy

Cited by 11 publications

References 121 publications

Comparison Between Elective Versus Emergency Caesarean Section on Intra Operative Surgical Findings and Feto Maternal Outcomes

Comparison Between Elective Versus Emergency Caesarean Section on Intra Operative Surgical Findings and Feto Maternal Outcomes

"Urological Surgical Injuries in Gynecology and Obstetrics. 10-Year Review"

A delayed diagnosis of iatrogenic ureteral injury results in increased morbidity

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