Urinary Tract Injuries during Obstetrics and Gynaecological Surgical Procedures at the Aga Khan University Hospital Karachi, Pakistan: A 20-Year Review

Abstract

Objective: To determine the prevalence of urinary tract injuries, identification of risk factors and methods employed for repair and their outcomes. Study Design: Cross-sectional study of patients who had urinary tract injuries during major obstetric and gynaecological surgeries at the Aga Khan University Hospital (AKUH) from 1985 to 2004. Material and Methods: Computer-generated discharge summaries of patients who underwent major obstetric and gynaecological procedures during the 20 years of study period were retrieved. Information was collected on data collection form, and entered in SPSS version 13 and analysed. Results: During the study period 12,567 obstetrics and 5,966 gynaecological procedures were performed. There were 3,910 abdominal hysterectomies, 984 myomectomies, 591 ovarian/ adenexal surgeries and 481 vaginal hysterectomies. Out of these 110 urinary tract injuries were identified, 71 (64.5%) were of the urinary bladder and 39 (35.5%) were ureteric in origin, 31 (43.6%) bladder injuries were sustained during caesarean sections while 40 (56.3%) were during gynaecological procedures. In obstetric cases there were two ureteric injuries, the other ureteric injuries were sustained during surgeries for benign gynaecological conditions. The prevalence of bladder and ureteric injuries in obstetric surgeries was 0.25 and 0.02%, respectively, whereas in gynaecological surgeries the prevalence was 0.7 and 0.6% for urinary bladder and ureteric injuries. These figures compare well with other published series. Conclusion: Urinary tract injuries are an uncommon occurrence but when they occur they have serious implications in terms of morbidity and litigation. The prevalence of urinary bladder and ureteric injuries observed in our review is comparable to previous reported international series. Of concern is the fact that most of the ureteric injuries were diagnosed post operatively which means that further vigilance and preventive strategies need to be designed.

Systematic review of urological injury during caesarean section and hysterectomy

“…As >15 caesarean section cohorts were identified, the largest 15 were selected, representing 144,816 women [ 22 , 27 , 30 , 35 , 44 , 59 , 61 , 70 , 77 , 80 , 88 , 90 , 99 , 105 , 107 ]. In total, 312 bladder and 7 ureteric injuries were reported.…”

Les traumatismes urétéraux compliquant une chirurgie gynécologique

“…L’estimation globale de la fréquence des lésions opératoires de l’uretère est très variable suivant les séries analysées allant de 0.5 à 30% [ 2 , 3 ]. En fait cette fréquence dépend de plusieurs facteurs.…”

A Review on the Etiology, Prevention, and Management of Ureteral Injuries During Obstetric and Gynecologic Surgeries

“…The possible causes of iatrogenic ureteric injuries include gynecologic procedures like abdominal hysterectomy, vaginal hysterectomy, anterior colporrhaphy, laparoscopic hysterectomy; 8 obstetric causes and predisposing factors like cesarean hysterectomy, fetal macrosomia, cephalopelvic disproportion, placenta previa, and morbidly adherent placentas involving the pelvic sidewalls, difficult neonatal extraction, prolonged labor, and abnormal fetal lie. 9 , 10 Other risk factors for iatrogenic injury include causes of pelvic adhesion like the previous surgeries, 11 endometriosis, and prior radiation therapy, advanced abdominopelvic cancers, 12–14 enlarged uterus at hysterectomy, cervical fibroids, and broad ligament fibroids, limited experience of the surgeon, bleeding, and excessive use of diathermy, 3 and transvaginal retrieval of oocytes (TOVR). 15 …”