Clinical Characteristics of Iatrogenic Injuries in Urinary Tract after Obstetric and Gynecologic Surgery

Lee, Ji Hyun; Kim, Young Joo; Huh, Jung Sik; Chang, Sung Goo

Abstract

PURPOSE: Injuries to the urinary tract are most likely to result from pelvic surgery. Injuries might lead to intense morbidity and mortality unless treated promptly. This review discusses the causes, diagnosis and management of injuries to the urinary tract result from obstetric and gynecologic surgery.
MATERIALS AND METHODS
Seventy six patients with iatrogenic injuries to the urinary tract that occurred during obstetric and gynecologic surgeries, between 1986 and 2003, were enrolled in the study.
RESULTS
Fifty bladder injuries, 19 ureter injuries, 5 vesicovaginal fistulae and 2 ureterovaginal fistulae are presented. The ureteral injuries included: 11 transections (52.4%), 8 ligations (38.1%) and 2 ureterovaginal fistulae (9.5%). The initial operations complicated by urologic injuries were: TAH in 39 patients (51.3%)., cesarean sections in 17 (22.4%), bladder injuries in 49 and transected ureteral injuries in 11, which were promptly diagnosed and primarily repaired. However, 8 ureteral ligations, 2 ureterovaginal fistulae and 5 vesicovaginal fistulae had delayed diagnoses. In these cases, ureteral stenting and a nephrostomy can be used as the first approach to controlling the injury. A double-J catheter insertion only was performed in 2 cases, ureteral balloon dilatation 3 and open repair in the others.
CONCLUSIONS
Bladder injuries, more than ureter injuriesy, are caused by obstetric and gynecologic surgeries. However, the morbidity with ureter injuries is more severe than that of bladder injuries. The early diagnosis and urological intervention are important for the effectiveness of the treatment. Also, endourologic management is recommended for a ligated ureter.