Prevention and treatment of iatrogenic ureter and bladder injury / 解放军医学杂志

ABSTRACT

Objective To investigate the etiological factors and measures for prevention and treatment of iatrogenic ureteral and bladder injury during obstetric and gynecologic operations.Methods Iatrogenic ureteral and bladder injury happened in 31 patients,who underwent traditional gynecologic operation from June 1996 to May 2006 at the Department of Gynecology and Obstetrics of the Second Affiliated Hospital of Wenzhou Medical College.The etiological factors and treatment for iatrogenic ureteral and bladder injury were analyzed retrospectively.Results The median age of the patients was 44 years(ranged from 27 to 61years).2 cases of iatrogenic ureteral injury and 3 cases of iatrogenic bladder injury occurred in hysterectomy.3 cases of iatrogenic ureteral injury and 2 cases of iatrogenic bladder injure occurred in subtotal hysterectomy for precancerous lesion.5 cases of iatrogenic ureteral injury and 7 cases of iatrogenic bladder injury occurred in radical hysterectomy.One case of iatrogenic ureteral injury and 8 cases of iatrogenic bladder injury occurred in cesarean section.Intraoperative ureteral injury in 7 patients was repaired by end-to-end anastomosis,and intraoperative bladder injury in 15 patients were repaired during operation.In 4 patients the ureteral injury was found after operation,including 2 cases of ureterovaginal fistula,and the injury was repaired after resection of fistulas.Bladder injury was found in 5 cases after operation,and the injuries were repaired by closure of fistulas of bladder 3 months later.All cases recovered with no relapse during the follow-up period of 5 months to 10 years.Conclusions Iatrogenic injury occurs during gynecological surgery should be prevented first.Early discovery and effective treatments can achieve good therapeutic effects.