Urinary tract injuries of gynecologic surgery

ABSTRACT

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