Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Objective: To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury.Study design: The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries.Results: A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (N=34, 0.38%), ureteral (N=11, 0.12%) and/or urethral injury (N=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, P<0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, P=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (P=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (P=0.328)Conclusion: Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries.

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Bladder injuries during obstetrical and gynecological surgeries

International Surgery Journal ◽

10.18203/2349-2902.isj20172578 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2177

Author(s):

Beena Vaidya ◽

Manish Chaudhari ◽

Deep Parmar ◽

Vipul Chaudhari ◽

Taha Daginawala ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Bladder ◽

Primary Repair ◽

Bladder Injury ◽

Interventional Study ◽

Suprapubic Cystostomy ◽

Urinary Tract Injury ◽

Bladder Injuries ◽

Gynaecologic Surgery

Background: The reproductive and urinary tracts in women are closely related anatomically and embryologically. Knowledge of this anatomy plays an important role in the prevention of urinary tract injury during gynaecologic surgery. The primary approach to prevention is careful surgical dissection and knowledge of the position of urinary tract structures within the surgical field.Methods: Prospective interventional study consisted of 28 patients with obstetrics and gynecological surgeries was carried out at department of surgery, new civil hospital, Surat during December 15th to January 16th. Out of 28 patients 13 patients had bladder injuries which repaired and studied in detail.Results: Out of these 28 patients undergone various obstetrics and gynecological surgeries, 13 patients were having iatrogenic urinary bladder injuries. Bladder injury occurred commonly during in LSCS and in hysterectomies. Out of 13 urinary bladder injuries, 8 injuries repaired in 2 layers by Vicryl 2-0 without insertion of SPC and 5 injuries were managed by primary repair with vicryl 2-0 with insertion of SPC (SPC= suprapubic cystostomy).Conclusions: Surgery adjacent to or within urinary bladder continue to result in occasional iatrogenic injury. These injuries can be minor with no long-term sequelae, or they can result in significant morbidity and inconvenience to patients.

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A retrospective study of urological injuries during obstetrics and gynecological procedures

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202563 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2746

Author(s):

Sunil Kumar Samal ◽

Setu Rathod ◽

Kalaivani Thangavel

Keyword(s):

Clinical Presentation ◽

Tertiary Care ◽

Bladder Injury ◽

Obstetrics And Gynecology ◽

Management Option ◽

Ureteric Injury ◽

Obstetrics And Gynaecology ◽

Bladder Injuries ◽

High Degree ◽

Urological Injuries

Background: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital.Methods: The study was a retrospective analysis of all obstetric and gynecological surgeries over a period of 6 years from January 2014 to December 2019. Cases with the documented urological injuries during these procedures were analyzed further.Results: Total 8595 patients had undergone different obstetrics and gynecology procedures, out of which 5429 were obstetrics and 3166 were gynecology surgeries. Out of 3166 of gynecology procedures, there were 16 cases (0.5%) of bladder injuries and one case (0.03%) of ureteric injury. Out of 5429 cases of obstetric procedures there were 11 (0.2%) cases of bladder injury and one case (0.01%) of ureteric injury.Conclusions: The incidence urological injuries during obstetrics and gynecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.

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URINARY TRACT INJURIES FOLLOWING OBSTETRIC AND GYNECOLOGIC SURGERIES -A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL.

10.36106/ijsr/6332964 ◽

2020 ◽

pp. 67-68

Author(s):

Khumallambam Ibomcha Singh ◽

Konsam Jina Devi ◽

Kangjam Sholay Meitei

Keyword(s):

Urinary Tract ◽

Vesicovaginal Fistula ◽

Tertiary Care ◽

Ureteral Injury ◽

Gynecologic Surgery ◽

Bladder Injury ◽

Care Hospital ◽

Ureterovaginal Fistula ◽

Ureteral Injuries ◽

Urological Complications

Purpose: Urinary tract injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and morbidities. This study examined the clinical features of urologic complications following obstetric and gynecologic surgery and their management. Materials and Methods: We prospectively analysed 14,678 obstetric and gynecologic surgery cases from May 2015 to May 2019. Twenty-one patients with urological complications were enrolled. This study assessed the etiology and surgical approach, type, and treatment method of the urologic injury. Results: Of these 21 patients, 11 had bladder injury, 1 had ureteral injury, 1 had combined bladder and ureteral injury, 8 had vesicovaginal fistula and 5 had ureterovaginal fistula. With respect to injury rate by specific surgery, radical hysterectomy was the highest with 5 of 21 cases. Out of 11 cases of bladder injury, only one underwent laparoscopic bladder repair and the rest had transabdominal primary repair during surgery with a 100% success rate. Two of 7 ureteral injuries were identified intraoperatively. One underwent ureteroureterostomy and another had ureteroneocystostomy with no major complications. All 8 cases of vesicovaginal fistula had open transabdominal O’ connor repair and all 5 cases of ureterovaginal fistula were cured after ureteroneocystostomy following percutaneous nephrostomy. Conclusions: Urinary bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The types of injured states, diagnostic difficulty, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and necessary urologic intervention are important for better outcome.

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Indications and Complications of Obstetric Hysterectomy in a Tertiary Care Hospital of Lahore

Annals of King Edward Medical University ◽

10.21649/akemu.v24is.2506 ◽

2018 ◽

Vol 24 (S) ◽

pp. 831-835

Author(s):

Shamila Ijaz Munir ◽

Riffat Iqbal ◽

Shamsa Humayun ◽

Saima Chaudhary

Keyword(s):

Tertiary Care Hospital ◽

Placenta Previa ◽

Tertiary Care ◽

Haemorrhagic Shock ◽

Bladder Injury ◽

Care Hospital ◽

Maternal Complications ◽

Ureteric Injury ◽

Normal Delivery ◽

Risk Patients

OBJECTIVES: To find out the frequency of obstetric hysterectomy, its indications and associated maternal complications in a tertiary care hospital of Lahore, Pakistan. METHODOLOGY: This is a retrospective observational descriptive study. It was done in Department of Obstetrics and Gynaecology of a Tertiary Care Hospital, Lahore from Feb 2015 to Jan 2016. All the records of patients, who had undergone hysterectomy, within 24 hours of normal delivery or caesarean section, were reviewed. The details of age, parity, booking status, indication and Complications of operation were recorded on a predesigned proforma. RESULTS: The total deliveries during the period were 5, 754. Obstetric hysterectomy was performed in 26 patients. This gives frequency of the emergency obstetric hysterectomy in our unit to be 4.5/1000 births. The major indication was previous caesarean sections with placenta previa and/or accreta in 17 cases (65.38%), followed by massive postpartum haemorrhage due to uterineatony in 4 cases (15.38%), uterine rupture in 3(11.5%) and abruption placenta in 2 (7.6%). Most common complication was haemorrhagic shock seen in 14 patients. There were 5 cases of bladder injury, 2 Ureteric injury and 2 vault hematomas. Maternal deaths occurred in 3 cases. CONCLUSION: Emergency obstetric hysterectomy is increasing with increased frequency of caesarean sections and placenta previa and accreta. Antenatal booking of high risk patients, timely referral to tertiary care hospital with good surgical expertise and ICU care can reduce morbidity and mortality in such cases.

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Trauma to the urinary tract and other urological emergencies

Oxford Handbook of Urology ◽

10.1093/med/9780199696130.003.0011 ◽

2013 ◽

pp. 505-550

Author(s):

John Reynard ◽

Simon Brewster ◽

Suzanne Biers

Keyword(s):

Urinary Tract ◽

Pelvic Fractures ◽

Renal Trauma ◽

Trauma Treatment ◽

Radiological Assessment ◽

Initial Resuscitation ◽

Bladder Injuries ◽

Urethral Injuries ◽

Ureteric Injuries ◽

Urological Emergencies

Initial resuscitation of the traumatized patient 506 Renal trauma: classification, mechanism, grading 508 Renal trauma: clinical and radiological assessment 512 Renal trauma: treatment 516 Ureteric injuries: mechanisms and diagnosis 520 Ureteric injuries: management 522 Pelvic fractures: bladder and ureteric injuries 526 Bladder injuries 532 Posterior urethral injuries in males and urethral injuries in females ...

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High Riding Prostate: Epidemiology of Genitourinary Injury in Motorcyclists from a UK Register of over 12,000 Victims

Current Urology ◽

10.1159/000499251 ◽

2020 ◽

Vol 14 (2) ◽

pp. 105-112

Author(s):

Basil F. Moss ◽

Catherine E. Moss ◽

Patrick Dervin ◽

Thomas Lawrence ◽

Sophie Jones ◽

...

Keyword(s):

Pelvic Fracture ◽

Road Traffic ◽

Significant Proportion ◽

Body Armor ◽

Research Network ◽

Renal Trauma ◽

Urethral Injury ◽

Bladder Injury ◽

Bladder Injuries ◽

Urological Injuries

Background: The mechanism of motorcycle accidents (high speeds, pelvis behind fuel tank) may predispose to genitourinary injury (GUI) but the epidemiology is poorly understood. Previous studies have assessed GUI patterns in cyclists, and road traffic accident victims in general, but no study has analyzed GUI patterns in a large cohort of motorcyclists. Objectives: We aimed to better understand patterns of urological injuries among motorcyclists admitted to hospital. We aimed to determine any relationship between pelvic fracture and GUI patterns or severity. Methods: The Trauma Audit Research Network was reviewed to identify motorcyclists admitted between January 2012 and December 2016 (n = 12,374). Cases were divided into riders (n = 11,926) and pillion passengers (n = 448), and the data analyzed to identify urological injuries and their associations. The associations between pelvic fracture and other injury types were tested for significance by one- and two-way χ2. Results: GUI was identified in 6%. Renal trauma was the most common GUI among riders (4%) and pillions (2%). There was no statistically significant relationship between grade of renal trauma and presence of pelvic fracture. Urethral injury occurred in 0.2% of riders and passengers, and bladder injury in 0.4% of riders and 0.7% of pillions. Urethral and bladder injuries were positively associated with pelvic fracture, which was present in 81 and 92%, respectively. Testicular trauma occurred in 0.4% of riders and 0.7% of pillions. Body armor was recorded in 3% of casualties with urological trauma, and 3% overall. Conclusions: A significant proportion of motorcyclists brought to accident and emergency department have GUI, most commonly renal trauma. Pelvic fracture is more common in pillion passengers than riders, and associated with urethral and bladder injuries, but it does not predict severity of renal trauma. External genital injuries are rare, but we recommend examination in the tertiary survey, as consequences of missed injury are severe. Further research is needed to explore protective effects of motorcyclist clothing.

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Etiology and Ureteral Reconstruction Strategy for Iatrogenic Ureteral Injuries: A Retrospective Single-Center Experience

Urologia Internationalis ◽

10.1159/000511141 ◽

2021 ◽

pp. 1-7

Author(s):

Guangpu Ding ◽

Xinfei Li ◽

Dong Fang ◽

Han Hao ◽

Xuesong Li ◽

...

Keyword(s):

Remission Rate ◽

Laboratory Data ◽

Treatment Strategies ◽

High Volume ◽

Ureteric Injury ◽

Ureteral Reconstruction ◽

Ureteral Injuries ◽

Significant Difference ◽

Urological Procedures ◽

Ureteric Injuries

Objective: To analyze the etiology, characteristics, and ureteral reconstruction strategies of iatrogenic ureteric injuries in a high-volume center. Methods: Between September 2010 and August 2019, we retrospectively collected patients who underwent ureteral reconstruction due to iatrogenic ureteric injuries. Patient profiles, laboratory data, imaging studies, perioperative data, and complications were recorded. Results: Sixty-eight patients were enrolled in this study. The upper, middle, and lower thirds of the ureter were affected in 30, 2, and 36 cases, respectively. Of the 68 ureteric injuries, 69.1% occurred during urological procedures, followed by gynecological procedures, general surgery, radiotherapy, and orthopedic surgery. The majority of urological injuries (41, 87.2%) occurred due to stone removal. There was a significant difference in the age, sex, and location of ureteric injuries between the urological and nonurological groups. The median follow-up time was 17.9 months. The overall symptom remission rate was 91.2% and ranged from 87.5 to 100% for different reconstructive surgeries. Conclusions: Urological procedures were the most common cause of iatrogenic ureteric injury; thus, extra care should be taken. Timely detection and appropriate treatment of the ureteric injuries are necessary. Treatment strategies should be depended on the location and length of injury.

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Ureteric Injuries after Hysterectomy in a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.6684 ◽

2021 ◽

Vol 59 (239) ◽

Author(s):

Ratna Adhikari Khatri ◽

Arju Chand ◽

Sumana Thapa ◽

Shailaja Khadka ◽

Manish Thapa

Keyword(s):

Confidence Interval ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Pelvic Surgery ◽

Tertiary Care Center ◽

Sectional Study ◽

Ureteric Injury ◽

Cross Sectional ◽

Ureteric Injuries

Introduction: Pelvic surgery is the most common cause of iatrogenic ureteral injury. The incidence of ureteric injuries varies between skilled and inexperienced surgeons. The study aims to determine the prevalence of ureteric injuries sustained during hysterectomy in a tertiary care center of Nepal. Methods: A descriptive cross-sectional study involving the women attending the gynecological outpatient department of a tertiary care center of Nepal, for various benign and malignant conditions and later on underwent hysterectomy from June 2019 to June 2020 was done after obtaining ethical clearence from the Institutional Review Committee (Reference No. 245). Convenient sampling method was used. The data were entered in Excel and analyzed using Statistical Package for Social Sciences version 17. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Altogether, 1 (0.63%) (0.55-0.71 at 95% Confidence Interval) out of 159 patients sustained the ureteric injury during hysterectomy in a tertiary care center of Nepal. The injury was seen during the exploratory laparotomy for adnexal mass. The injury was recognized intraoperatively and was repaired with double J stenting. A total of 159 patients were enrolled in the study that had undergone hysterectomy over one year for various benign and malignant conditions. Out of which 21 (13.2%) had undergone surgeries for malignant conditions and 138 (86.79%) for benign conditions. Conclusions: Iatrogenic ureteric is still a major cause of harm and concern in hysterectomy. Patients with ureteric injury should be evaluated and intervened at the earliest.

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