INTRODUCTION: The purposes of the present retrospective study were to (1) evaluate the outcomes of emergency urological interventions during gynecological operations, and (2) offer management guidelines for the practicing urologist.
METHODS: The authors evaluated the records of 20 female patients with urinary tract injuries that occurred during gynecological operations between May 2003 and May 2005. The mean patient age was 28 years (range, 20-40 years). The patients were evaluated preoperatively by routine investigations, intraoperatively by ureteric catheterization and/or cystoscopy and ureteric catheterization, and postoperatively by sonography every 3 months for 1 year and by intravenous urography 6 months after surgery.
RESULTS: Urologic injury occurred during cesarean section (n = 12) and hysterectomy (n = 8). Six patients had bladder injuries that were repaired intraoperatively, followed by urethral catheterization. Fourteen patients had distal ureteral injuries that were repaired by ureteric catheterization and/or ureterovesical neoimplantation. Catheters were removed after 1 week. Six months after surgery, all patients had an intact upper urinary tract with no back pressure changes. No reflux or ureteric stricture was observed 1 year after surgical intervention.
CONCLUSION: Iatrogenic injuries to the urinary tract may occur during gynecological surgery. The bladder and distal ureters are the most commonly involved organs. Ureteral catheterization via a cystoscope or directly through the orifices should be used to assess the intactness of the ureter. Key factors to obtaining optimal results are early recognition and immediate repair of the damage.
KEYWORDS: Cesarean section; Ureter; Bladder injury; Cystoscopy; Ureteric catheterization; Ureterovesical reimplantation
CORRESPONDENCE: Ahmed Mohamed Shelbaia, Borg El Atbaa, Faisal Street, Giza, Egypt (; ).
CITATION: Urotoday Int J. 2010 Feb;3(1).
doi:10.3834/uij.1944-5784.2010.02.04