Urological injuries following obstetrical and gynecological surgeries

Abstract

Background: Gynaecological operations have been reported to be associated with injuries to the ureter. This study was aimed at reviewing the urological complications resulting from obstetric and gynaecological surgeries in respect to frequency, clinical presentations, and time of diagnosis. The study was undertaken at Departments of Obstetrics, Gynecology and Urology at Kilimanjaro Christian Medical Centre Tanzania from January 2009 to December 2014.

Methods: In this 6-year retrospective study, 11219 obstetrical and gynecological surgeries were performed. All patients who sustained urological injuries were reviewed and entered into a data sheet before analyzing their frequency, clinical presentation and the time of presentation.

Results: Of the 9221 obstetrical and 1998 gynecological surgeries performed, 105 (0.94%) were sustained urological injuries. A total of 82 patients had VVF (78%), 18 (17.2%) had ureteral injury, 4 (3.8%) patients had bladder injury only, and 1 patient (1%) had both VVF and Ureteral Injury. With respect to injury rate by specific procedure, caesarean section in obstetric surgeries contributed to 36 patients (34.3%) with urological injuries, whereas TAH was the leading gynecological procedure which contributed to 18 patients (17.1%) with urological injuries. All patients with VVF had history prolonged labor and presented with persistent urine leakage per vagina (urine incontinence). The time of diagnosis to most of the patients was more than 48 hours especially to patients with VVF. There were no patients with urethral injury.

Conclusion: Obstetric surgeries have shown to contribute to a higher number of urological injuries as compared to gynecological surgeries. Both VVF and ureteric injuries being the most common in obstetrics and gynecologic surgeries respectively have great economic and social impacts not only to the patients, but also the surrounding community and the country as a whole. Late presentation and diagnosis increases the risks of further complications. Early presentation, diagnosis and urologic intervention is important for the better outcomes.