Urological Injuries during Obstetric and Gynecological Surgical Procedures: Two Centers Experience

Objective: To retrospectively analyze the frequency and outcome of urological injuries in obstetric and gynecological surgical procedures in two medical centers. Patients and Methods: This retrospective study done for a total of 4710 patients, who underwent cesarean section (3870) and hysterectomy (840) operations in two centers (Al-Hussein University Hospital and Assiut University Hospital during time interval from January 2006 - March 2010. Detailed history and physical examination, and the investigations of the patients were carried out. Patients were operated by a senior surgeon, and those that suffered urological injury were analyzed. The nature of injury, the timing of diagnosis and methods of repair all were recorded. Results: During the study period 840 patients had underwent hysterectomy and 3870 patients underwent cesarean section (total 4710 patients). Urological injuries recorded in 46 (0.98%) patients. Sustained bladder injury was reported in 14 (1.7%) and 16 (0.41%) cases who underwent hysterectomy and caesarean section, respectively. All bladder injuries except one case diagnosed intraoperatively. Ureteric injury was seen in ten (1.19%) hysterectomy and six (0.15%) caesarean section patients; the injuries included ligation in 8 (0.16%) cases, transaction in 4 (0.08%), ligation and transaction in 3 (0.06%), and ureterovaginal fistula in 1 (0.02%) case. Intraoperative diagnosis of injuries was made in 5 (31.2%) and postoperative in 11 (68.8%) patients. Cases of bladder injury were treated by formal surgical repair and bladder drainage, while patients with ureteric injury were treated by surgical repair and/or ureteral stenting. Conclusion: Urological injuries though uncommon, yet add significant contribution to morbidity. To reduce the morbidity from urological injuries in obstetric and gynecological procedures, careful preoperative workup, and in difficult cases anticipation and suspicion of the injury is essential.