Approach to prevention and preventive measures of urinary tract injury in gynecological surgery

Abstract

Background: Operative injuries to the urinary tract are not uncommon in gynecological surgery due to the proximity of the urogenital organ systems. Urinary tract injury constitutes an estimated 0.2–1% of all gynecologic procedures and pelvic operations. Urinary tract injuries due to obstetric and gynecologic surgery are classified into two categories: Acute complications, such as bladder or ureteric injury that can be identified and repaired immediately during the operation, and chronic complications such as vesicovaginal fistula (VVF), ureterovaginal fistula (UVF) which can discover days to months after primary surgery. Aim of the study: to evaluate the most common iatrogenic injury to urinary tract following gynecological surgery in order to prevent life threating and troublesome complications that impact patients’ quality of life and to make a guideline and preventive measures and protocol that reduce the rate of serious complications. Patients and methods: a prospective study from January 2011 to December 2021, the total number of patients included in the study was 37 with genitourinary injuries following obstetric and gynecologic surgery. Result: the mean age of patients was 32 years. Out of 37 patients, acute complications seen in 31 patients (83.7%) while chronic complications seen only in 6 patients (16.2%). the urinary bladder was the most frequently injured (20 patients) followed by ureter (13 patients) while the least injured structure was the urethra (one patient). most iatrogenic urinary tract injuries occur during abdominal hysterectomy and noted in 22 patients while cesarean section was the case of injury in 15 patients.