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

Abstract

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 becomplicated 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 thevaginal 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 notdiffer according to annual number of surgeries performed, but increases with the vaginal surgeries.