Urinary tract injuries of gynecologic surgery

Urinary tract injuries occur more often in gynecologic surgery than in any other surgery. 75% of urinary fistulas are due to gynecological surgeries, and the incidence of urinary tract injuries related to gynecologic surgery is about 1-3%. The early detection of the urinary injury during surgery gives more chance for correction without any postoperative complications. In the Maternity Hospital a study, covering 5 years [1992-1996], was conducted. It aimed at being a statistical research on the urinary tract injuries, the value of their early detection, the methods of avoiding them and the best ways of management. Ureter Injury: 24 cases were studied. Ureteral ligation was the most common injury; and cesarean section was the leading causative surgery in this type of injury [50%], after it comes the postpartum hysterectomy [20.8%] and the least causative surgery was the vaginal hysterectomy [4.1%] The study showed that the rate of ureteral damage was 0.1% of all cesarean sections, 5.37% all postpartum hysterectomies, 2% of all radical hysterectomies and 0.18% of all vaginal hysterectomies. Therefore 0.14% of ureteral injuries were due to obstetric operations and 0.35% to gynecologic operations. The obstetric causes constituted 71% of all injuries, and the gynecologic causes constituted 29% of all injuries. The rate of recognized injuries during operations was 62.5% and they were all repaired. Bladder injury: 70 cases were studied [0.45% of all surgeries.]. The obstetric causes [cesarean section. postpartum hysterectomy] were the leading causes [71.4%], specially due to recurrent cesarean sections. The rate of bladder injury during cesarean sections was 0.34% all cesarean sections, 10.7% of all postpartum hysterectomies [relatively it is considered an elevated rate], 0.6% of all abdominal hysterectomies, 1.57% of all vaginal hysterectomies. 95.7% of the injuries were recognized during operations and the surgical success rate was 94%. We reached the following considerations: 1- Enhancement the obstetric management. 2- Enhancement of surgical techniques and following all surgical recommendations and adequate sterilization. 3- Pre - and post - operative IVP if necessary. 4- The early and direct detection of the tract injury and its suitable management and treatment

Urinary tract infections during the pregnancy

Urinary tract infection is the most common bacterial infection in adult women and it is an important complication associated with pregnancy, because it is common and affecting the health of fetus and pregnant woman. The aim of this research has been the statistical studying of symptomatic and nonsymptomatic urinary tract infections associated with pregnancy; the effect of some diseases associated with pregnancy on urinary infection, the influence of this infection on the health of pregnant, fetus and progress of pregnancy; its relationship to the preterm labor and prematurity and to reach a better method in prevention and treatment. This study has been done during 5 years between 1992-1997 in the University Hospital of Obstetrics on 2500 cases of nonsymptomatic pregnancies, 683 cases of pregnancy associated with symptomatic urinary infection and comparison groups. The symptomatic urinary tract infection rate [Cystitis and Pyelonephritis] reached up to 4.46% in the pregnant groups visiting our clinic. The rate of nonsymptomatic bacteriuria was 12.2%. The study has shown that both the frequency of symptomatic and nonsymptomatic infection increase by progression of age, multiparity and the second trimester of pregnancy. Symptoms particularly polyuria and dysuria [shown in 75% of patients], associated with dilation of the urinary voiding canal exist in 70% of pregnancy affected by pyelonephritis, which is detected by radiography and ultrasonography. However the incidence was 15% in patients with nonsymptomatic bacteruria, and 9% in normal pregnant. E. coli was the most important bacteria which caused urinary tract infection in our study [involved in 51.4% of symptomatic cases of infection and 75.05% of asymptomatic cases of infection]. It is obvious that urinary tract infections in pregnant females increase in the presence of anemia, diabetes or hypertention. However, the rate of nonsymptomatic bacteruria is doubled in the cases with anemia, diabetes or hypertension, [from l2.2% to 29%]. Our study also revealed an increase in the presence of these diseases in the cases of symptomatic and nonsymptomatic urinary infection. In addition, the most important complications of pregnancy with urinary tract infection are preterm delivery and prematurity which explain an increasing rate of low-birth weight newborns [lower than 2500g] associated with urinary tract infection; and these low-birth weight newborns were seen in 3.13% of the cases of negative urine culture, 4.88% of the cases of positive urine culture, 7.04% of the lower urinary tract infection and reached up 15.66% in the presence of Pyelonephritis. All cases were treated according to the results of antibiogram. The rate of recovery with the treatment of repeated doses of ampicilline [86.05% of cases] was better than the one-dose treatment [76.09% of cases]. The nonsymptoniatic urinary tract infection relapsed at the rate of 2.86% and reinfection at the rate of 8.57%. However, lower urinary tract infection relapsed at the rate of 2.1% and reinfection at the rat of 6.84%. Pyelonephritis relapsed at the rate of 1.98% and reinfection at the rate of 4.63%. Finally, we reached up some necessities, performing an overall screening and urine culture to every pregnant woman who visits any clinic for the first time during pregnancy, repeating them in the case of a metabolic lesion and after treatment, active treatment of all urinary tract infections associated with pregnancy according to the result of the antibiogram, [by the manner of repeated], preventive treatment of recurrent infection, following - up patients after treatment via urine culture and insuring eradication of urinary tract infection