Asifa Ghazi, Pervez Iqbal, Mohammad Saddique.
Bladder and Ureter injuries during obstetric and gynecological procedures.
Pak J Surg Jan ;24(1):53-6.

Objective: To determine the frequency and nature of urological injuries in obstetric and gynaecological procedures in our setup. Design & Duration: A case series from January 1998 to June 2007. Setting: Departments of Gynaecology & Obstetrics (Unit III) of Civil Hospital, and two private hospitals of Karachi. Patients: A total of 3140 patients, who underwent Caesarean section (2580) and hysterectomy (560) operations were included in the study. Methodology: 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 analysed. The nature of injury and the timing of diagnosis was studied. Results: Out of the 560 patients that underwent hysterectomy 10(1.7%) patients and amongst the 2580 Caesarean section patients 12(0.46%) sustained bladder injury; accidental cystostomy occurred in 14 and minor perforation in eight cases. Ureteric injury was seen in seven (1.25%) hysterectomy and four (0.15%) Caesarean section patients; the injuries included ligation in 5(0.15%) cases, transection in 3(0.09%), ligation and transection in 2(0.06%), and urinary fistula in 1(0.03%) case. Intra-operative diagnosis was made in 3(27.3%) and postoperative in 8(72.7%) patients. Cases of bladder injury were treated by formal surgical repair, while patients with ureteric injury were treated by surgical repair and stenting. Conclusion: To reduce the morbidity from urological injuries in obstetric & gynaecological procedures, careful pre- operative workup, and in difficult cases anticipation and suspicion of the injury is essential.

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